Neurology Flashcards
1
Q
Stroke is a T1 or T2?
A
T1
2
Q
CVA stands for
A
Cerebral Vascular Attack/ Stroke
3
Q
FAST stands for
A
Face: facial paralysis
Arm: One arm doesn’t work
Speech: speech issues
Time: get tx during acute stroke
4
Q
TIA stands for
A
Transient Ischemic attack (aka Mini stroke)
5
Q
A mini stroke is a stroke that
A
Doesn’t last. Whatever causes it goes away
6
Q
MS stands for
A
MULTIPLE SCLEROSIS
7
Q
MS is a disease of ______ of a nerve
A
Demyelination
8
Q
MS can be present in the eye. It is called:
A
Optic neuritis
9
Q
Optic nerve is ____ due to swelling from MS. This causes _____ vision loss
A
elevated, inflamed
Temporary
10
Q
Optic atrophy is caused by ____.
A
MS
11
Q
Myasino Gravis, you get fatigued muscles because
A
Acetylcholine is not allowed to get into the muscle
12
Q
Parkinson’s Disease is caused by a decrease in _____
A
Dopamine
13
Q
Lumbar puncture or spinal tap is done at the 3rd and 4th lumbar vertebrae due to increased
A
Pressure increase in CSF
14
Q
Spinal tap is done for
A
increased intracranial pressure
15
Q
Multiple Sclerosis Pathophysiology:
A
- Strong genetic association (no single gene is responsible)
- Demyelination with axonal damage
- Autoimmune
16
Q
Demyelination with axonal damage is limited to _______, ______ and ______ in MS.
A
White matter; spinal cord; optic nerve
17
Q
Describe the autoimmune phathophysiological effect of MS.
A
Antibodies are directed towards the myelin antigens and accumulation of macrophages are found in areas of myelin loss.
18
Q
Typical age of onset for MS:
A
Young adults: 20-40 yrs
19
Q
Choose one:
Women/men are affected twice more in MS.
A
Women
20
Q
Black people are affected twice more than other races by MS.
T/F
A
F: white people are.
21
Q
Which gender is more affected by MS and which one has better prognosis?
A
Women, women
22
Q
Signs and symptoms of MS:
A
- Slow nerve conduction
- Laermitte’s sign
- Atrophy of optic nerve, optic chiasm, axons, and spinal cord
- Focal numbness, double-vision, unilateral blurred vision
- tingling and weakness in limbs
- Shortens lifespan by a few years
- Paresthesia
23
Q
Define Laermitte’s sign.
A
An electric shock that runs down the arms or back when bending the neck.
24
Q
Name a symptom of an early stage MS.
A
Unsteadiness, which progresses to attacks of spinning vertigo
25
What is parasthesia?
An abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.
26
What are possible tests for MS?
-Presence of O-bands in CSF protein after electrophoresis test indicates presence of MS
-10 lesions
in the white matter in
2 places at 2 times
will indicate MS
-Use of interferon B1A
27
What are some treatments for MS?
- Azothioprine (immunosuppressant)
| - Cortical steroids
28
What is the pathophysiology of Myasthenian Gravis (MG)?
-Immune disorder
- Antibodies in postsynaptic Ach receptors presents, preventing depolarization of membrane, which results in weakness and fatigue.
- Thymus disorders
29
Typical age of onset for Myasthenia Gravis is:
20-40 yr women (more common in women)
40-60 yr men
30
Signs and symptoms of MG:
- Weakness of voluntary muscles
- Fatigue of external ocular and facial muscles
- Insidious onset
- Difficulty chewing and swallowing
- Worsened by pregnancy and infections
- Difficulty breathing
31
What disease do these symptoms/effects correlate with?
- Worsened by pregnancy and infections
- Difficulty breathing
Myasthenia Gravis (MG)
32
Treatments for Myasthenia Gravis:
- Surgery
- Medications and plasmaphoresis
- Removal of thymus
- Corticosteroids
33
What causes Parkinson's disease?
- Caused by encephalitis, drugs, and toxicity
- Loss of cells and an essential protein
- Imbalance of Ach and dopamine in corpus striatum
34
What is the age of onset for Parkinson's Dz?
Older usually
35
signs/symptoms of Parkinson's:
- Tremors, rigidity, and abnormal gait
- Hypokinesia (slow movement)
- Classic "Parkinson's stare"
36
Treatment for Parkinson's Dz:
- Suppress Ach and use dopamine agonists
- Surgery
- Restore balance of neurotransmitters
37
elevated inter-cranial pressure is caused by:
- Arterial blood flow is compromised ->ischemia + edema of the brain tissue -> ICP rises
- Herniation due to unilateral tumor and shift in brain tissue over a fixed intercranial structure.
- Brain tumor, brain abscess, encephalitis, AV malformations, MS and pseudotumor cerebri
38
Signs/symptoms of elevated ICP:
- Earliest symptom: lethargy and fatigue
- Inability to stay awake, which is an early sign of slipping into a coma
- decreased level of consciousness and response to stimuli
- Limb paralysis
- Respiration pattern changes (rate and depth increase)
39
What Dz can cause edema, ischemia, and herniation of brain tissue
Elevated inter-cranial pressure
40
What is syncope?
Decrease in arterial BP and pulse leading to hypoperfusion of cerebral hemispheres
orthostatic hypotension (head rush)
41
How does a seizure occur?
Derangement in the synchronized discharge of the cerebral neurons
42
What is epilepsy?
Recurrent seizures
43
Common age of onset for syncope:
Common in all ages
44
Common age of onset for seizures:
Starts in patients under 25 yro
45
Symptoms of syncope:
```
Fainting
light headedness
nausea
blurred vision
pale skin and dilated pupils
```
46
Signs/symptoms of seizures:
convulsions and memory loss
47
Treatment for syncope:
- Put pt horizontal (may get again if standing up)
- Hydrate pt
- Place wet washcloth on head or back of neck
48
Treatment for seizures (as well as epilepsy):
No treatment given if pt has had a single seizure.
Otherwise, use anticonvulsants such as carbamazepine and phenytoin
49
What is the first drug of choice to control seizures?
phenytoin
50
Sub-types of muscular dystrophies:
- Duchenne's
- Becker's
- Limb-girdle
- Facialscapulohumeral
51
How does one get muscular dystrophies?
- Inherited
| - disorder resulting in musculoskeletal deformities and muscular contractures
52
What is the pathophys. of myotonic disorders?
Inability for muscle to relax after contraction
53
Symptoms for muscular dystrophies:
Muscle weakness and wasting
54
Symptoms for myotonic disorders:
Muscle stiffness
55
Pathophys. for Wilson's Dz:
- Disease of copper metabolism
| - Caused by genetics, derangement of copper transport protein cerulopasamin
56
Kayser-fleiser rings of the cornea is caused by:
| dark circles around the iris
Wilson's Dz
57
Signs/symptoms of Wilson's Dz:
-Kayser-fleiser rings of the cornea
-Anemia, chronic liver cirrhosis
-Enlarged spleen
-Dementia
Dysphagia
-Memory issues
-Personality changes
-Tremor
58
Pathophys. of acoustic neuroma:
- benign tumor which will cause hearing loss and tinnitus
- CN5 affected, facial sensory loss
- CN7 affected, facial muscle weakness
59
Age of onset for acoustic neuroma:
people older than 20
| most commonly, 40-60 yro
60
Signs and symptoms of acoustic neuroma:
Hearing loss and tinnitus
And as it progresses, difficulty with walking and ataxia (loss of control of body movements)
61
Treatment for acoustic neuroma:
Surgery to preserve CN7 and 8
62
Acoustic neuroma is aka:
vestibular schwannoma
63
Meningioma pathophys:
- Benign tumors arise from the arachnoid meningeal cells
- Very common! 1/7 of all intercranial tumors
- Grow slowly and attain large size before symptoms noticed
64
Meningioma age of onset:
- occurs with increasing age
| - common in women
65
Symptoms and sign for Meningioma:
Depend on the location
66
Glioma pathophys:
- Most common malignant tumor in the US
- Low grade glioma: astrocytoma
- Grade III anaplastic
- Grade IV glioblastoma
67
Low grade glioma age of onset:
-usually found in patients 5-30 yro
68
Grade III glioma age of onset:
ages 30-50 yr
69
Grade IV glioma age of onset:
Occurs in pts older than 50
70
Low grade glioma treatment:
Observe
71
Grade III glioma treatment:
Radiation and chemo
| survival rate is 3-4 yrs
72
Grade IV glioma treatment:
With radiation and chemo survival rate is 1 yr at best!
73
It is impossible to surgically remove all types of this brain tumor:
Glioma
74
Treatment for elevated ICP:
- Vascular therapy
- Osmotic therapy
- Metabolic therapy
- Surgical intervention
75
Define stroke:
An acute neurologic deficit of the CNS that persists for at least 24 hrs and is caused by a reduction in cerebral circulation.
76
Age of onset for stroke:
- In symptom-free men and women 30-60 yro
| - Untreated systemic hypertensive pts 7x more likely to develop stroke
77
Stroke occur more commonly in ____.
Men
78
Pathophys of stroke:
- ischemia (produced by embolism or thrombosis)
- hemorrhage (brain tissue damage due to toxicity, pressure effects on the intercranial structures, increase in ICP, compression of the vascular supply leading to ischemia)
79
How does ischemia result in stroke?
-Interruption of blood flow, oxygen, and glucose -> loss of membrane potential -> K leaks out of the cell -> influx of Na -> neurological cells swell => neuron cell death
80
How does hemorrhage cause a stroke?
- Bleeding and edema cause compression in the brain tissue (don't destroy cells)
- Neuro-function regain is possible.
81
Stroke symptoms:
- Almost always isolated to the side of brain opposite the deficit.
- Clear evidence of a stroke based on signs and symptoms should prompt a neurologic exam to pinpoint the anatomic location of the lesion.
82
Transient ischemic attack treatments:
- Antiplatelet therapy
- Aspirin
- Ticlopidine
- Clopidogrel
- Anticoagulant therapy
- Carotid endraterectomy (surgery)
- Thrombolytic therapy
83
Treatment for stroke:
Any stroke in evolution requires anticoagulants.
Completed strokes from a cardiac source: treated with antiplatelet and anticoagulant meds.
Stroke with intercranial or vertebrobasilar source: treated with antiplatelets, anticoagulants and thrombolytic agents.
84
Define transient ischemic attack:
Episodes of neurologic deficits that imply a stroke but only last an average of 30 minutes.
Hallmark: complete resolution of the symptoms and signs.
85
The most common cause of transient ischemic attack:
thrombosis or embolism of the cerebral vasculature.
86
transient ischemic attack symptoms:
- unilateral blur-outs of vision that last for seconds to minutes
- This mandates retinal examination to exclude the presence of a Hollenhorst plaque within the retinal arterial tree of the involved eye.
87
Name the tier 1 neulogic Dz:
1. Stroke
2. Transient Ischemic Attack
3. Multiple Sclerosis
4. Myasthenia Gravis
5. Parkinson's
6. Elevated intracranial pressure (including pseudotumor cerebri)
88
MS and MG are tier 1 or tier 2 Dz?
Tier 1
89
Name the tier 2 neurologic Dz:
1. Epilepsy
2. Muscular dystrophies
3. Myotonic disorders
4. Wilson's
5. Glioma
6. Meningioma
7. Acoustic neuroma
90
Glioma and acoustic glioma are tier:
2
91
Epilepsy is tier:
2
92
Stroke and transient ischemic attacks are tier:
1
93
Stroke risk factors:
- blood pressure
- atrial fibrillation
- smoking
- cholesterol
- diabetes
- exercise
- diet
- stoke in family
94
Face
Arm
Speech
Time
Are used to determined the signs of which disease?
Stroke
