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Clinical Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

Stroke is a T1 or T2?

A

T1

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2
Q

CVA stands for

A

Cerebral Vascular Attack/ Stroke

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3
Q

FAST stands for

A

Face: facial paralysis
Arm: One arm doesn’t work
Speech: speech issues
Time: get tx during acute stroke

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4
Q

TIA stands for

A

Transient Ischemic attack (aka Mini stroke)

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5
Q

A mini stroke is a stroke that

A

Doesn’t last. Whatever causes it goes away

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6
Q

MS stands for

A

MULTIPLE SCLEROSIS

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7
Q

MS is a disease of ______ of a nerve

A

Demyelination

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8
Q

MS can be present in the eye. It is called:

A

Optic neuritis

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9
Q

Optic nerve is ____ due to swelling from MS. This causes _____ vision loss

A

elevated, inflamed

Temporary

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10
Q

Optic atrophy is caused by ____.

A

MS

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11
Q

Myasino Gravis, you get fatigued muscles because

A

Acetylcholine is not allowed to get into the muscle

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12
Q

Parkinson’s Disease is caused by a decrease in _____

A

Dopamine

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13
Q

Lumbar puncture or spinal tap is done at the 3rd and 4th lumbar vertebrae due to increased

A

Pressure increase in CSF

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14
Q

Spinal tap is done for

A

increased intracranial pressure

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15
Q

Multiple Sclerosis Pathophysiology:

A
  • Strong genetic association (no single gene is responsible)
  • Demyelination with axonal damage
  • Autoimmune
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16
Q

Demyelination with axonal damage is limited to _______, ______ and ______ in MS.

A

White matter; spinal cord; optic nerve

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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.

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18
Q

Typical age of onset for MS:

A

Young adults: 20-40 yrs

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19
Q

Choose one:

Women/men are affected twice more in MS.

A

Women

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20
Q

Black people are affected twice more than other races by MS.
T/F

A

F: white people are.

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21
Q

Which gender is more affected by MS and which one has better prognosis?

A

Women, women

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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
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23
Q

Define Laermitte’s sign.

A

An electric shock that runs down the arms or back when bending the neck.

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24
Q

Name a symptom of an early stage MS.

A

Unsteadiness, which progresses to attacks of spinning vertigo

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25
Q

What is parasthesia?

A

An abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.

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26
Q

What are possible tests for MS?

A

-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

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27
Q

What are some treatments for MS?

A
  • Azothioprine (immunosuppressant)

- Cortical steroids

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28
Q

What is the pathophysiology of Myasthenian Gravis (MG)?

A

-Immune disorder

  • Antibodies in postsynaptic Ach receptors presents, preventing depolarization of membrane, which results in weakness and fatigue.
  • Thymus disorders
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29
Q

Typical age of onset for Myasthenia Gravis is:

A

20-40 yr women (more common in women)

40-60 yr men

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30
Q

Signs and symptoms of MG:

A
  • Weakness of voluntary muscles
  • Fatigue of external ocular and facial muscles
  • Insidious onset
  • Difficulty chewing and swallowing
  • Worsened by pregnancy and infections
  • Difficulty breathing
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31
Q

What disease do these symptoms/effects correlate with?

  • Worsened by pregnancy and infections
  • Difficulty breathing
A

Myasthenia Gravis (MG)

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32
Q

Treatments for Myasthenia Gravis:

A
  • Surgery
  • Medications and plasmaphoresis
  • Removal of thymus
  • Corticosteroids
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33
Q

What causes Parkinson’s disease?

A
  • Caused by encephalitis, drugs, and toxicity
  • Loss of cells and an essential protein
  • Imbalance of Ach and dopamine in corpus striatum
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34
Q

What is the age of onset for Parkinson’s Dz?

A

Older usually

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35
Q

signs/symptoms of Parkinson’s:

A
  • Tremors, rigidity, and abnormal gait
  • Hypokinesia (slow movement)
  • Classic “Parkinson’s stare”
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36
Q

Treatment for Parkinson’s Dz:

A
  • Suppress Ach and use dopamine agonists
  • Surgery
  • Restore balance of neurotransmitters
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37
Q

elevated inter-cranial pressure is caused by:

A
  • 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
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38
Q

Signs/symptoms of elevated ICP:

A
  • 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
Q

What Dz can cause edema, ischemia, and herniation of brain tissue

A

Elevated inter-cranial pressure

40
Q

What is syncope?

A

Decrease in arterial BP and pulse leading to hypoperfusion of cerebral hemispheres

orthostatic hypotension (head rush)

41
Q

How does a seizure occur?

A

Derangement in the synchronized discharge of the cerebral neurons

42
Q

What is epilepsy?

A

Recurrent seizures

43
Q

Common age of onset for syncope:

A

Common in all ages

44
Q

Common age of onset for seizures:

A

Starts in patients under 25 yro

45
Q

Symptoms of syncope:

A 
Fainting 
light headedness 
nausea 
blurred vision 
pale skin and dilated pupils
46
Q

Signs/symptoms of seizures:

A

convulsions and memory loss

47
Q

Treatment for syncope:

A
  • Put pt horizontal (may get again if standing up)
  • Hydrate pt
  • Place wet washcloth on head or back of neck
48
Q

Treatment for seizures (as well as epilepsy):

A

No treatment given if pt has had a single seizure.

Otherwise, use anticonvulsants such as carbamazepine and phenytoin

49
Q

What is the first drug of choice to control seizures?

A

phenytoin

50
Q

Sub-types of muscular dystrophies:

A
  • Duchenne’s
  • Becker’s
  • Limb-girdle
  • Facialscapulohumeral
51
Q

How does one get muscular dystrophies?

A
  • Inherited

- disorder resulting in musculoskeletal deformities and muscular contractures

52
Q

What is the pathophys. of myotonic disorders?

A

Inability for muscle to relax after contraction

53
Q

Symptoms for muscular dystrophies:

A

Muscle weakness and wasting

54
Q

Symptoms for myotonic disorders:

A

Muscle stiffness

55
Q

Pathophys. for Wilson’s Dz:

A
  • Disease of copper metabolism

- Caused by genetics, derangement of copper transport protein cerulopasamin

56
Q

Kayser-fleiser rings of the cornea is caused by:

dark circles around the iris

A

Wilson’s Dz

57
Q

Signs/symptoms of Wilson’s Dz:

A

-Kayser-fleiser rings of the cornea
-Anemia, chronic liver cirrhosis
-Enlarged spleen
-Dementia
Dysphagia
-Memory issues
-Personality changes
-Tremor

58
Q

Pathophys. of acoustic neuroma:

A
  • benign tumor which will cause hearing loss and tinnitus
  • CN5 affected, facial sensory loss
  • CN7 affected, facial muscle weakness
59
Q

Age of onset for acoustic neuroma:

A

people older than 20

most commonly, 40-60 yro

60
Q

Signs and symptoms of acoustic neuroma:

A

Hearing loss and tinnitus

And as it progresses, difficulty with walking and ataxia (loss of control of body movements)

61
Q

Treatment for acoustic neuroma:

A

Surgery to preserve CN7 and 8

62
Q

Acoustic neuroma is aka:

A

vestibular schwannoma

63
Q

Meningioma pathophys:

A
  • 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
Q

Meningioma age of onset:

A
  • occurs with increasing age

- common in women

65
Q

Symptoms and sign for Meningioma:

A

Depend on the location

66
Q

Glioma pathophys:

A
  • Most common malignant tumor in the US
  • Low grade glioma: astrocytoma
  • Grade III anaplastic
  • Grade IV glioblastoma
67
Q

Low grade glioma age of onset:

A

-usually found in patients 5-30 yro

68
Q

Grade III glioma age of onset:

A

ages 30-50 yr

69
Q

Grade IV glioma age of onset:

A

Occurs in pts older than 50

70
Q

Low grade glioma treatment:

A

Observe

71
Q

Grade III glioma treatment:

A

Radiation and chemo

survival rate is 3-4 yrs

72
Q

Grade IV glioma treatment:

A

With radiation and chemo survival rate is 1 yr at best!

73
Q

It is impossible to surgically remove all types of this brain tumor:

A

Glioma

74
Q

Treatment for elevated ICP:

A
  • Vascular therapy
  • Osmotic therapy
  • Metabolic therapy
  • Surgical intervention
75
Q

Define stroke:

A

An acute neurologic deficit of the CNS that persists for at least 24 hrs and is caused by a reduction in cerebral circulation.

76
Q

Age of onset for stroke:

A
  • In symptom-free men and women 30-60 yro

- Untreated systemic hypertensive pts 7x more likely to develop stroke

77
Q

Stroke occur more commonly in ____.

A

Men

78
Q

Pathophys of stroke:

A
  • 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
Q

How does ischemia result in stroke?

A

-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
Q

How does hemorrhage cause a stroke?

A
  • Bleeding and edema cause compression in the brain tissue (don’t destroy cells)
  • Neuro-function regain is possible.
81
Q

Stroke symptoms:

A
  • 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
Q

Transient ischemic attack treatments:

A
  • Antiplatelet therapy
  • Aspirin
  • Ticlopidine
  • Clopidogrel
  • Anticoagulant therapy
  • Carotid endraterectomy (surgery)
  • Thrombolytic therapy
83
Q

Treatment for stroke:

A

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
Q

Define transient ischemic attack:

A

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
Q

The most common cause of transient ischemic attack:

A

thrombosis or embolism of the cerebral vasculature.

86
Q

transient ischemic attack symptoms:

A
  • 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
Q

Name the tier 1 neulogic Dz:

A
  1. Stroke
  2. Transient Ischemic Attack
  3. Multiple Sclerosis
  4. Myasthenia Gravis
  5. Parkinson’s
  6. Elevated intracranial pressure (including pseudotumor cerebri)
88
Q

MS and MG are tier 1 or tier 2 Dz?

A

Tier 1

89
Q

Name the tier 2 neurologic Dz:

A
  1. Epilepsy
  2. Muscular dystrophies
  3. Myotonic disorders
  4. Wilson’s
  5. Glioma
  6. Meningioma
  7. Acoustic neuroma
90
Q

Glioma and acoustic glioma are tier:

A

2

91
Q

Epilepsy is tier:

A

2

92
Q

Stroke and transient ischemic attacks are tier:

A

1

93
Q

Stroke risk factors:

A
  • blood pressure
  • atrial fibrillation
  • smoking
  • cholesterol
  • diabetes
  • exercise
  • diet
  • stoke in family
94
Q

Face
Arm
Speech
Time

Are used to determined the signs of which disease?

A

Stroke

Clinical Medicine (7 decks)

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