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Master the Boards Step 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Transient loss of vision in one eye in setting of TIA =

A

amaurosis fugax

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2
Q

The first branch of the internal carotid artery is the

A

opthalmic artery (why amaurosis fugax happens in TIA)

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3
Q

TIAs are NEVER caused by

A

hemorrhage; always by emboli or thrombosis

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4
Q

Anterior cerebral artery lesion symptoms =

A

contra lower extremity weakness
personality changes
urinary incontinence

mild UE weakness

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5
Q

Middle cerebral artery lesion symptoms=

A 
Profound contra upper extremity weakness
Aphasia
Apraxia/neglect
Eyes deviate TOWARD the lesion side
Contra hemonymous hemianopsia w/ macular sparing
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6
Q

Posterior cerebral artery lesion symptoms =

A

Prosopagnosia (inability to recognize faces)

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7
Q

Vertebrobasilar artery lesion symptoms =

A 
Vertigo
Nausea/vomiting
Loss of consciousness (drop attack)
Vertical nystagmus
Dysarthria and dystonia
Sensory changes in face/scalp
Ataxia
BILATERAL FINDINGS
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8
Q

Posterior inferior cerebellar artery lesion symptoms =

A

Ipsilateral face
Contralateral Body
Vertigo and Horner’s syndromes

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9
Q

Lacunar infarct symptoms =

A 
ABSENCE of cortical deficits
Ataxia
Parkinsonian signs
Sensory probs
Hemiparesis (mostly face)
Possible bulbar signs
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10
Q

Which test can be positive for stroke within an hour?

A

MRA

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11
Q

Always do what before treating a stroke?

A

NON CON HEAD CT

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12
Q

An intracranial neoplasm or mass is an absolute contraindication to

A

thrombolytic therapy for stroke

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13
Q

CPR within 3 weeks that was traumatic is an absolute contraindication for

A

thrombolytic therapy for stroke

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14
Q

Up to 6-8 hours after a stroke, what can be done?

A

Catheter retrieval of the clot (removes it like a corkscrew

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15
Q

Best initial therapy for those arriving late for stroke care?

A

Aspirin!

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16
Q

Which antiplatelet agent is ALWAYS the wrong answer?

A

Ticlopidine! No added benefit and it can cause TTP and neutropenia

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17
Q

Manage __ stroke and __ stroke the same way

A

Anterior and middle cerebral artery strokes are managed the same way

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18
Q

What needs to be done after initial stroke treatment?

A

Echo to look for clot origin
Carotid dopplers
EKG and holter monitor if EKG is normal
If a-fib is present, start warfarin, dabigatran, or rivaroxaban

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19
Q

Young patients w/ no PMH who present with stroke should also have which tests?

A

ESR
VDRL or RPR for syphilis
ANA, double stranded DNA
Protein C, S, Factor V Leiden mutation, Antiphospholipid syndromes

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20
Q

The younger the patient, the more likely the stroke is caused by

A

Vasculitis or hypercoagulable state

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21
Q

Are thrombolytics indicated for TIA?

A

NO

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22
Q

Therapy for status epilepticus =

A

Benzos
Fosphenytoin if persists after 10-20 min
Phenobarb after another 10-20 min
General anesthesia after yet another 10-20 min

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23
Q

Which blood tests need to be done on seizing patient?

A 
Sodium
Calcium
Glucose
Creatinine
Magnesium
Liver and renal function
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24
Q

Which non-blood tests need to be done for seizing patient?

A

Urine toxicology screen

Head CT urgently

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25
Q

When should a first seizure patient be started on chronic antiepileptics?

A

Strong family hx of seizures
Abnormal EEG
Status epilepticus requiring benzos
Brain tumor

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26
Q

First line antiepileptics =

A

valproic acid
carbamazepine
phenytoin
leviteracetam

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27
Q

What is an AE of lamictal (lamotrigine)?

A

Stevens Johnson syndrome and severe skin reactions

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28
Q

Absence or petit mal seizures should be treated with

A

Ethosuximide

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29
Q

Treat mild parkinson’s disease under age 60 with

A

anticholinergic agents such as Benztropine or Hydroxyzine

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30
Q

Treat mild parkinson’s over age 60 with

A

Amantadine due to danger of anticholinergics in the elderly

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31
Q

First line tx for severe parkinson’s includes

A

Levodopa/Carbidopa and dopamine agonists (pramipexole, ropinirole, cabergoline)

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32
Q

Additional meds for parkinson’s if first line failes include

A

COMT inhibitors (tolcapone, entacapone)
MAOi’s
Deep brain stimulation last resort

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33
Q

COMT inhibitors block dopamine metabolism and work best with

A

Dopamine based medications

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34
Q

The most common abnormality in multiple sclerosis is

A

optic neuritis

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35
Q

Best initial dx test AND most accurate test for MS is

A

MRI

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36
Q

Is there any reason to order a CT for MS?

A

NO

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37
Q

What will you find on CSF of multiple sclerosis?

A

Oligoclonal bands ONLY if MRI is nondiagnostic

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38
Q

Disease modifying therapies for MS include

A

beta interferon, glatiramer, mitoxantrone, natalizumab, fingolimod, or dalfampridine

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39
Q

An anti-CD52 drug that inhibits lymphocytes and deters progression of MS is

A

Alemtuzumab

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40
Q

What is an adverse effect of natalizumab?

A

PML

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41
Q

For ALL patients with memory loss, order

A

Head CT
B12 level
Thyroid function testing
RPR or VDRL

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42
Q

Head CT showing diffuse, symmetrical atrophy =

A

Alzheimer’s disease MAYBE (dx of exclusion)

43
Q

Standard of care for Alzheimer’s =

A

Anticholinesterase inhibitors such as donepezil, rivastigmine, and galantamine

44
Q

Pick’s disease, aka frontotemporal dementia, will show __ on head CT or MRI

A

focal atrophy of the frontal and temporal lobes. Treat the same as Alzheimers!

45
Q

Rapidly progressive dementia and presence of myoclonus =

A

Creutzfeldt-Jacob Disease. Patients way younger than Alzheimers

46
Q

CSF shows ___ in CJD

A

14-3-3 protein (spares the patient a brain biopsy

47
Q

Parkinson’s disease + dementia =

A

Lewy Body dementia, VERY VERY VIVID hallucinations

48
Q

Wet, Wobbly, Wacky =

A

Normal pressure hydrocephalus. Treat w/ shunt

49
Q

Dx NPH with

A

LP plus clinical picture (normal pressure duh)

50
Q

Diagnose Huntington’s Disease/ Chorea with

A

specific genetic testing, inheritance is autosomal dominant

51
Q

Give ___ for huntingtons movement disorder

A

tetrabenazine

52
Q

Best initial abortive therapy for migraine is

A

sumatriptan or ergotamine

53
Q

4 or more migraines per month, ppx with

A

beta blockers

54
Q

Best initial therapy for cluster headache is

A

triptans or 100% oxygen

55
Q

Ppx for cluster headaches =

A

calcium channel blockers such as verapamil

56
Q

Dx test for temporal arteritis =

A

ESR is best initial test, but temporal artery biopsy is most accurate!

57
Q

Delay in steroid treatment for temporal arteritis can result in

A

permanent vision loss

58
Q

Obese young woman with headache and double vision =

A

pseudotumor cerebri

Vitamin A use can cause!

59
Q

LP in pseudotumor cerebri will show

A

markedly elevated pressure

60
Q

Treat pseudotumor cerebri with

A

weight loss
Acetazolamide
Surgery if those fail

61
Q

Generally all patients with vertigo should have what test?

A

MRI of the internal auditory canal

62
Q

Vertigo alone with no hearing loss, no tinnitus, and no ataxia =

A

Benign positional vertigo

63
Q

Idiopathic inflammation of the vestibular portion of the 8th cranial nerve

A

Vestibular neuritis

64
Q

Is there hearing loss or tinnitus in vestibular neuritis?

A

NO

65
Q

Treat vestibular neuritis with

A

meclizine

66
Q

Labyrinthitis is inflammation of

A

the cochlear portion of the inner ear

67
Q

What are symptoms of labyrinthitis?

A

Hearing loss and tinnitis; self-limited

68
Q

Treat Meniere’s with

A

salt restriction and diuretics

69
Q

Ataxia + hearing loss + tinnitus + vertigo =

A

Acoustic neuroma (8th cranial nerve tumor, related to Von Recklinghausen’s)

70
Q

Treat Wenicke-Korsakoff syndrome with

A

Thiamine first, then glucose

71
Q

When a CNS infection is suspected, some patients will require you to

A

Do a head CT BEFORE an LP if there is a history of CNS disease, FND, papilledema, seizures, altered consciousness, or significant delay in the time to perform the LP

72
Q

Gram negative pleomorphic occobacillary organisms on CSF =

A

Haemophilus

73
Q

A normal protein level in CSF essentially excludes

A

bacterial meningitis

74
Q

Glucose levels below 60 percent of serum levels are consistent with

A

bacterial meningitis

75
Q

Best initial therapy for cryptococcus is

A

amphotericin and 5-flucytosine, followed by oral fluconazole

76
Q

Treat lyme disease with

A

IV ceftriaxone or penicillin

77
Q

Treat Rocky Mountain spotted fever with

A

doxycycline

78
Q

The single most accurate test in TB of CSF is

A

PCR!

79
Q

How to treat amoebic meningitis

A

Miltefosine and maybe amphotericine; steroids may help

80
Q

Fever + AMS+ photophobia + stiff neck =

A

encephalitis

81
Q

Almost all encephalitis in the US is caused by

A

Herpes

82
Q

How to dx encephalitis?

A

PCR, NOT brain biopsy

Treat with acyclovir

83
Q

Ring-enhancing brain lesion basically means either __ or __

A

cancer or infection

84
Q

Brain lesions of progressive multifocal leukoencephalopathy are not associated with

A

ring-enhancement or mass effect

85
Q

Patient from Mexico with a seizure =

A

neurocysticercosis

86
Q

Multiple 1cm cystic lesions on head CT =

A

neurocysticercosis; treat with albendazole

87
Q

Neuro symptoms in the setting of hypertensive crisis, preeclampsia, or cytotoxic meds like cyclosporine =

A

Posterior Reversible Encephalopathy Syndrome

88
Q

What is the goal pCO2 when trying to constrict cerebral blood pressures in increased ICP?

A

pCO2 of 28-32 (hyperventilation)

89
Q

Do steroids help intracranial hemorrhage?

A

NO

90
Q

Head trauma, burns, and ET intubation with mechanical ventilation can have what adverse effect?

A

Stress ulcers; treat with PPIs

91
Q

Subarachnoid hemorrhage is associated with what EKG finding?

A

T-wave inversion

92
Q

To be sure an increased WBC is a sign of infection, check the

A

ratio of WBCs to RBCs (normal is 1:500)

93
Q

Diagnose syringomyelia with

A

MRI

94
Q

ALS is treated with

A

Riluzole

95
Q

How does Riluzole work?

A

Blocks accumulation of glutamate in ALS

96
Q

Wasting, fasciculations, and weakness are ___ motor neuron signs

A

Lower

97
Q

Radial nerve palsy results in __

A

wrist drop

98
Q

High boots pressing at the back of the knee can lead to

A

peroneal nerve palsy; self limiting

99
Q

Treat bell’s palsy with

A

steroids

100
Q

Chronic regional pain syndrome, AKA reflex sympathetic dystrophy, can be treated with

A

NSAIDs, gabapentin, and occasionally nerve block. Surgical sympathectomy may be necessary

101
Q

The most urgent step in suspected Guillain Barre is

A

peak inspiratory pressure due to impending diaphragm weakness

102
Q

Best initial test for myasthenia gravis =

A

Anti-acetylcholine receptor antibodies

103
Q

If pyridostigmine or neostigmine do not work for myasthenia gravis, last resort is

A

thymectomy for <60 yo

Master the Boards Step 3 (19 decks)

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