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PANCE REVIEW > Neurology > Flashcards

Neurology Flashcards

1
Q

Amaurosis fugax

A

Monocular vision loss- temporary “lamp shade down one eye”. Seen in TIA from internal carotid artery

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2
Q

Pathophysiology of Huntington dz

A

Autosomal dominant neurodegenerative d/o of cerebral/caudate nucleus atrophy

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3
Q

Clinical symptoms of Huntington dz

A

1) dementia
2) chorea: rapid involuntary movements
3) behavioral changes

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4
Q

Pathophysiology of Parkinson’s dz

A

Idiopathic dopamine depletion with unspooled acetylcholine

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5
Q

What part of the brain does Parkinson’s effect

A

Basal ganglia

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6
Q

Clinical manifestations of Parkinson’s

A

1) tremor: resting
2) bradykinesia
3) rigidity
4) instability
5) fixes facial expression

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7
Q

Parkinson’s treatment

A

Levodopa /carvadopa (levodopa is converted to dopamine )

  • dopamine agonist
  • anticholinergics ( decrease acetylcholine)
  • MAOI ( selegiline)
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8
Q

Pathophysiology of Guillain Barre Syndrome

A

Demyelination of peripheral nerves following a URI

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9
Q

MC bacteria predisposing a patient to Guillian Barre

A

Campylobacter jejuni

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10
Q

Diagnosis of Guillain barre syndrome

A

CSF!!!!!

*high protein with normal WBC, “albuminocytological dissociation”

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11
Q

Treatment of Guillain Barre

A

1) plasmaphoresis
2) IVIG
* PREDNISONE CONTRAINDICATED

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12
Q

Pathophysiology of myasthenia Gravis

A

Autoantibodies against acetylcholine receptors, inhibiting skeletal muscle firing

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13
Q

What other d/o is highly associated with myasthenia Gravis? (75%)

A

Thymine abnormality: hyperplasia or thymoma

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14
Q

Management of myasthenia Gravis

A

Pyridostigmine: acetycholinesterase inhibitors

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15
Q

Pathophysiology of multiple sclerosis

A

Autoimmune inflammatory demyelination of the CNS

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16
Q

3 types of multiple sclerosis

A

1) relapsing remitting (MC)
2) Progressive: constant decline without exacerbations
3) secondary progressive: relapsing-remitting that becomes progressive

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17
Q

Clinical manifestations of MS

A

1) SENSORY: trigeminal neuralgia, worse with heat (uhthoff phenomonon) , Lhermitte sign (neck flexion sends pain down leg)
2) OPTIC: optic neuritis , Marcus-Gunn pupil (dilates on swinging light test)
3) UPPER MOTOR NEURON: spasticity with babinski
4) BLADDER: incontinence
5) CHARCOT’s NEURO TRIAD: 1) nystagmus 2) tremor 3) staccato speech

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18
Q

MS diagnosis

A

1) MRI with gadolinium : at least 2 white matter plaques

2) LP: IgG oligoclonal bands

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19
Q

Acute MS exacerbation to

A

1) steroids

2) plasmapheresis

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20
Q

Relapsing remitting / progressive multiple sclerosis TX

A

Beta-interferon

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21
Q

Medications that can precipitate actor angle closure glaucoma

A

sympathomimetics, anticholinergics

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22
Q

Patient complaints when experiencing actor glaucoma

A

unioccular pain, HALOS around lights, peripheral vision loss, tunnel vision

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23
Q

physical exam in acute angle closure glaucoma

A

steamy cornea, fixed-non reactive pupil

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24
Q

Management of glaucoma

A
  1. acetazolamide (decreases aqueous humor production)

2. timolol drops (decreased intra ocular pressure.

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25
Q

Treatment of choice for absence seizures

A

ethosuxamide

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26
Q

treatment of status epilecticus

A

lorezapam (increases GABA)
phenytoin (blocks Na channels)
phenobarbital (binds to GABA to increase it)

27
Q

In what nerve distribution is Bell’s palsy and what disease does it have a strong association with?

A

Cranial nerve VII

associated with HSV reactivation

28
Q

Is there eyebrow involvement in bell’s palsy?

A

YES, there must be complete paralysis of that side of face

29
Q

Bell’s palsy treatment

A

prednisone

30
Q

Abortive drugs for migraine headaches

A

*the goal is to increase serotonin and decrease dopamine which will cause vasoconstriction. **do not use these drugs if any CAD or PVD present.

1) Triptans and Ergotamines (increase serotonin)
2) Metachlopromide (decrease dopamine) **give with benadryl to prevent tariff dyskinesias

31
Q

Prophylactic drugs for migraine headaches

A

HTN meds such as BB, CCB, TCA, AED

32
Q

Essential tremor:

aggravating and alleviating factors and treatment

A

ACTION tremor, relieved with alcohol

treat with propranolol

33
Q

Actute and prophylactic treatment of cluster headaches

A

actute=100% oxygen, 6-10 L

prophylactic=VERAPAMIL

34
Q

How is the brain effected in a patient with alzheimers ?

A

amyloid deposition, neurofibrillary tangles (tau proteins), as well as cerebral cortex atrophy **causes a cholinergic deficiency

35
Q

Alzheimers treatment

A

1) ach-esterase inhibitors; Donepezil (aricept)

2) NMDA antagonist ; memantine

36
Q

4 types of dementia and their ahllmarks

A

1) alzheimers; memory first
2) Vascular; from many lacunar infarcts
3) Frontotemporal dementia; picks dz, PERSONALITY changes
4) Lewy Body Dementia; hallucinations, delusions, parkinsonism

37
Q

What is the MC primary CNS tumor in adults

A

glioblastoma multiforme aka grade IV astrocytoma

38
Q

What is a cushion’s reflex?

A

irregular respirations, hypertension, bradycardia in the presence of severe glioblastoma multiform

39
Q

Glioblastoma multiforme presentation on CT or MRI

A

mass with hypodense center, a variable ring of enhancement surrounded by edema

40
Q

Meningioma hallmarks

A

usually benign, arise from DURA

-on bx you may see spindle cells, whorled pattern, or psammoma bodies (calcifications)

41
Q

CNS lymphoma hallmarks

A
  • epstein barr virus is a risk factor
  • ring enhancing lesions on imaging
  • methotrexate is the most effective chemo
42
Q

Hallmarks of hemangiomas

A
  • MC from the brainstem and cerebellum

- foam cells with high vascularity on bx

43
Q

most common pathogen and tx for meningitis in a child

A

group B. strep, listeria

tx with ampicillin

44
Q

most common pathogen and tx for meningitis in 1mon-18 year old

A

nisseria meningitis , s. pneumo

tx with ceftriaxone and vancomycin

45
Q

most common pathogen and tx for meningitis in 18-50 y/o

A

S. pneumo, N. meningitis

tx with ceftriaxone and vancomycin

46
Q

most common pathogen and tx for meningitis in adult >50

A

S. pneumo, listeria

tx with ceftriaxone and ampicillin maybe vancomycin

47
Q

in what age ranges are you concerned about listeria meningitis

A

less than one month

greater than 50 years

48
Q

What causative organism of meningitis is highly associated with the petechial rash

A

N. meningitis

49
Q

LP findings consistent with bacterial meningitis

A

LOW glucose
high protein
neutrophils

50
Q

LP findings consistent with viral meningitis

A

NORMAL glucose
lymphocytes
normal protein

51
Q

MC cause of encephalitis

A

HSV, you can treat with valcyclovir

52
Q

Treatment for restless leg syndrome?

A

Pramipexole, Ropinirole

-These are dopamine agonists

53
Q

What is Broca’s Aphasia?

A

Frontal lobe nonfluency, comprehension preserved with sparse output (you can understand what is being said to you, but you can’t formulate a response)

54
Q

What is Wernicke’s aphasia?

A

Fluent aphasia (voluminous, meaningless) with markedly impaired comprehension

(you are speaking a lot of nonsense, but can’t comprehend what is being said to you)

55
Q

Treatment of a TIA

A

ASA and plavix

56
Q

Workup of a TIA

A
  • CT head
  • Carotid u/s
  • CT or MR angiography
  • Blood glucose
  • Echo
57
Q

What are the 4 presentations of a lacunar infart?

A
  1. Pure motor (MC)
  2. Ataxic hemiparesis worse in leg than arm
  3. Dysarthria clumbsy hand syndrome
  4. Pure sensory loss
58
Q

An infarct in the middle cerebral artery would present how?

A
  • UPPER EXTREMITY involvement
  • Facial droop opposite lesion
  • gaze towards the side of the lesion
59
Q

An infarct in the anterior cerebral artery would present how?

A
  • LOWER EXTREMITY
  • face spared
  • personality changes, flat affect
  • urinary incontinence
60
Q

An infarct in the posterior cerebral artery would present how?

A

Visual hallucinations, contralateral homonymous hemianopsia, drop attacks

61
Q

What is xanthocromia?

A

Yellowing of the CSF due to subarachnoid hemmorhage

62
Q

Side effects of dilantin/phenytoin

A

gingival hyperplasia, rash, hypotension, arrythmia

63
Q

Order of treatment in status epilepticus

A
  1. Benzo-lorazepmam is most effective because it has the shortest 1/2 life
  2. Phenytoin-stabilizes neuronal membranes without causing CNS depression
  3. Phenobarbitol-binds to GABA receptor to potentiate GABA mediated CNS inhibition

PANCE REVIEW (15 decks)

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