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PANRE > Neurology > Flashcards

Neurology Flashcards

1
Q

cerebrum

A

cortex functions in higher brain processes- controls voluntary.
frontal lobe: reasoning, problem solving, parts of speech, movement and emotion
parietal: perception, auditory stimuli, and speech
temporal : memory
occipital : visual

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2
Q

pons

A

regulates breathing

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3
Q

basal ganglia disorders

A 
movement disorders - it helps with the coordination of movements (dyskinesia, dystonias, parkinson's, huntington;s)
behavior control (tourette's and obsessive compusive)
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4
Q

parkinsonism

A

parkinson disease, dopamine antagonistic meds (haldol, metoclopramide),
Lewy body disease- loss of dopaminergic neurons.- recurrent hallucinations that are visual

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5
Q

TRIPTANS cannot be used with

A

Contraindications to their use include: ischemic heart disease (including coronary artery vasospasm [Prinzmetal angina], angina pectoris, myocardial infarction); stroke, transient ischemic attack, history of hemiplegic or basilar migraine; peripheral vascular disease (including ischemic bowel disease); uncontrolled hypertension; severe hepatic disease, `

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6
Q

rabies

A

negri body

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7
Q

Trigeminal neuralgia

A

common in MS

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8
Q

viral meningitis

A

most common cause is enterovirus

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9
Q

encephalitis

A

mc is herpes simplex

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10
Q

resting tremors

A

parkinson

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11
Q

postural tremor

A

occurs when holding position against gravity

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12
Q

lewy body disease

A

loss of dopaminergic aneurons- similar to parkinson symptoms - DEMENTIA (due to loss of anticholergic neurons), RECURRENT visual hallucination

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13
Q

huntington

A

caudate nucleus atrophy
-behavioral, chorea, dementia
cerebral and caudate nucleus atrophy
manage chorea- antidopaminergics. benzo for chorea and sleep

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14
Q

essential familial terror

A

BILATERAL!!!!- hands, forearms, head, neck and voice- worse with emotional stress and intentional movement
shortly relieved with ETOh
TX: PROPRANOL

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15
Q

parkinson’s

A

dopamine depletion- no inhibition of ACH in basal ganglia- LEW BODIES!!- loss of pigment cells seen in substantia nigra
RESTING TREMOR- pill roll- bradykinesia, rigityt, cogwhell, fixed facial expressions.
MYERSON: tap bridge of nose repetitively causes a sustained blink
INSTABILITY wth gait.

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16
Q

TX For parkinsons

A 
levodopa/carbidopa: most effective!!!
dopamine agonists: bromocriptine
anticholinergics: (cuz parkinsons has too much ACH that are not inhibited- benztropine, trihexyphenidyl)- for the tremors
Amantadine- increases dopamine release
MA-B inhibits: selegline , rasagiline
COMT inhibitors: entacapone, tolcapone
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17
Q

tourette syndrome

A

ASSOCIATED WITH Obsession compulsions
- too much dopamine also in basal ganglia
BLOCK THE DOPAMINE- haldol, risperdal

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18
Q

ALS lou gherig’s idsease

A

necrosis of both upper and lower motor neurons- eventual respiratory dysfunction
upper: spasticity, stiffness, hyperreflexia
lower motor neuron: bilateral fasciculations, muscle atrophy, hyporeflexia
SENSATION, URINARY sphincter, and volutnary eye movements ARE SPARED

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19
Q

cerebral palsy

A

injury during prenatal period= spasticity- UMN- development disability
BACLOFEN for the spasticty

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20
Q

REStless legs syndrome

A

sleep-related movement disorder
SECONDARY from CNS iron deficiency
- itching, burning, paresthesias in the leg that gives urge to move legs- worse at night- improves with movement
TX; DOPAMINE AGONISTS: pramipexole, ropinirole
GABAPNETINE
BENZO
opioids

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21
Q

GBS guillain barre syndrome

A

incidence with campylobacter jejuni- MC.
demyelinating polyradiculopathy of the peripheral nerves
SYMMETRIC weakness and paresthesias- immune response reacts with peripheral nerve components
ASCENDING WEAKNESS AND paresthesais - decreased DTR, breathing difficulty

TX:
plasmaphereissis!!!
IVIG!!!
DONT GIVE PREDNISONE

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22
Q

myasthenia gravis

A

autoimmune PERIPOHERAL nerve disroder
mc in young women
tymic ABNORMALITIES- hyperplasai or thymoma

AUTOIMMUNE ABX against ACETYLCHOLINE postsynaptic receptor at the NEUROMSUCULAR junction!- progressive weakness with repeated muscle use and recovery after periods of REST!

  1. ocular weakness, generalized ocular weakness- diplpia, eyelid weakness, PTOSIS!!!, generalized msucle weakness throughout the day- gets better with rest. BULGBAR weakess: with prolonged chewing
    respiratory uscle wekness- myasthenic crissis!!
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23
Q

myasthenia dx and tx

A

dx: aceytlcholine receptor antibodies,
edrophonium test: rapid repsonse to short active edrophoium!!
CT SCAN - shows thymomA!!

tx:acetylcholinesterase inhibitors: pyridostigmine!!!!- incresaes acetylchonline!!!
PLASMAPHEREISIS OR IVIG!!- for myasthenic crisis!!
thymectomy

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24
Q

lambert-eaton

A

myastehnic syndrome- associate with sall cell lung cancer- weakness IMPROVES WITH REPEATED USE in LAMBERT~

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25
Q

MS

A

autoimmune- demylination of white amtter!!!
relapsing- remitting disease in the most common
TRIEGMINAL NEURALGIA!!!, worsening symptoms with heat, OPTIC NUERITIS!!!- unilateral eye pain worse with movements, diplolpia, central scotomas, vision loss (COLOR)- MARCUS-gunn pupil- pupils dilate in affected eye- during swinging flashing light
UPPER MOTOR NEURON- spasticitiy and positive babinski!!!

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26
Q

DX of Multiple SCLEROSIS

A

MRI- WHITE matter plaques!!!!!!!
lumbar puncture: iGG oligoclonal bands in CSF

ACUTE: IV corticosteroids and plasmapheriesis!!!
relapse-remitting: b interferron or glatiramere acetate

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27
Q

bells palsy

A

CNVII- facial nerve palsy- HEMIFACIAL weakness/paralysis due to infallmmmation and compression
LOWER MOTOR NEURON LESION
HERPES SIMPLEx VIRUS REACTIVATION
one side ear pain(hyperacusis), unilateral facial paralyasis, unable to lift affected eyebrow, wrinkle froward, smile on affecte side, drooping of the croenr of mouth, TASTE issues (anterior 2/3),

tx: prednisone
artificial TEAR!!!!

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28
Q

tension headaches

A

bilateral tight, band like vise like
no nausea, vomiting or focal neurologic symptoms
NSAIDS, Aspiprin, acetaminophen, ELAVIL
prophylaxis;: beta blockers

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29
Q

migraine headaches

A

migraine without aura
or migraien with aura( calssiC)
pulsatile/throbbing headache nausea, vomiting, photophobia, phonophobia- egoh, chocolate red wine makes it worse
aurus: visiual changes= light flashes, zig zag lines of light, scotomas, aphasia
auras usually last less than 60 minute!!! and then headache onset!!

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30
Q

tx for migraines

A

abortive: triptans or ergotamines: vasoconstriction- seratonin 5ht1 agonists!!- CI: CORONARY artery or peripheral vascular disease, unctrolled HTN!

dopamien blockers: METOCLOPRAMIDE!!!, promethazine
GIVEN WITH DIHYDRAMMINE TO PREVENT EPS, dystonic reactions

mild: nsaids
prophylactic: beta blockers, calcium channel blockers, TCA, anticonvulsants, NSAIDS

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31
Q

Trigeminal neuralgia

A

brief, episodic, stabbing/lancinated pain- worse with touch, eating, drafts of wind and movements- often UNLITERLA!
CARBAMAZEPINE!!!!!

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32
Q

cluster headache

A

unilateral periorobial/temporal pain- less than 2 hours!!!!!
several times a day over 6-8 weeks
ETOH, stress of ingestion of specific foods, WORSE AT NIGHT~
horner’s syndrome (ptosis, miosis, anhydrosis), nasal congestion/rhinorrhea, conjunctivitis and lacriatmation

TX: 100% oxygen, anti migraine meds- SQ sumatriptan!!!!,

VERAPAMIL - first line for propylaxis

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33
Q

pseudotuor cerebri

A

increased intracranial pressure- worse with strainging, visual changes- may lead to blindenss if not treated
MC I NOBESE children!

papilledema!!!
CT SCAN , then lumbar pucnture

TX: ACETAZolamidE!!!!!

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34
Q

normal pressure hydrocephalus

A 
normal opening pressure on lumbar puncture- but dilation of the cerebral ventricles
DEMENTIA
GAIT DISTURBANCE
URINARY INCONTINENCE!!!!
ventriculoperitnieal shunt- tx
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35
Q

concussion

A

mild traumatic brain injury- alteration in mental status
confusion, amnesia
ehadache, dizzines,s visual, emotional instability, vomiting
ct scan
cognitive and physical rest: tx

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36
Q

delirium

A

transient confused state, rapid onset, fluncuating mental status change, SHORT TERM MEMORY !

37
Q

dementia

A 
chronic intellectual deterioration- memory loss and loss of impulse control!!!
alzehimer's
vascular
frontotemporal
diffuse lewy body
38
Q

alzheimemrs

A

amyloid deposition= tau protein, cholinergic deficiency
1st- short term memroy loss, then long term, disorteintation, behavioral and personality changes
cerebral cortex atrophy on ct scan
DONEZEPIL, tACRINE, rivastigmie, galantamine
memantine- nmda antagonist!!!

39
Q

vascular dementia

A

lacunar infarcts- htn - 2nd most common

40
Q

front to temporal

A

picks disease- brain gdegenration- marked personality changes!!!!!

41
Q

diffuse lewy body

A

visual hallucinations, delusions!!

42
Q

astorcytoma

A

pilocytic astrocrytoma- grade I- most benign- mc in children and young adults
GRADE IV= glioblastoma-multiforme- mc primary cns tumors in ddauldts

43
Q

glioblastoma multiforme

A

most caggressive of all the primary cns tumors in adults!!

cushings reflex: irregular respiratoions, htn, brady

44
Q

meningiomas

A

usually BENIGN Tumors!!
associated with neurofibromatoisis NF 2
attached to the dura
spindle cells

45
Q

atlast c1 burst fracture

A

jefferson!!!!

46
Q

hangmans’

A

c2!!!! may lead to sponyloslisthesis between c2 and c3

47
Q

cords

A

anterior cord : lower extremity more than upper
central cord: upper extremity more than lower- shawn distribution for sensory deficit
posterior cord: LOSS OF proprioception and vibratory sense only
brown sequard: ipsilateral motor, vibration and proprioception deficites (dorsal).Contralateral pain and temp deficients!!

48
Q

non dominant side

A

usually right hemisphere: contralateral left hemiparesis, left neglect, apraxia: purposely movements can’t be done, flat affect, impaired judgement, impulsev

49
Q

dominant side lesisons

A

usually the left hemisphere: right hemiparesis, right sensory loss, aphsia (can’t remember words), agraphia , decreased math compresnsions

50
Q

TIA

A

due to embolus!!-internal caroitd artery
vertebrobrasilar: brain/Stem and cerebellar- gait, proprioception

Ct scan of head
caroitd dopper
- mroe than 70% of carotid steoniss - do a surgery
ct angio
echo to look for cardioembloci source

ASPIRIN, clopidogrel!!- no thrombolytics!!!!!!- supine increases cerebral perfusion!!! no blood pressure changes unless more than 220/120!!!

51
Q

lacunar

A

small vessel disease- pure motor mc, dysarthria, HISTORY OF HTN!!!!

52
Q

mmiddle cerebral artery (MOST COMMONLY AFFECTED BY ISCHEMIC STROKE)

A

MOST COMMON TYpE!!!
greater in face and arm than foot and leg
THROMBOlytICs within 3 hours!!! 4.5 hours in some cases!!!
alteplase!!!
antiplatelet therapy
anticoag if cardioembolic
185/110 or higher- lower for thromblytic otherwise don’t!

53
Q

ischemic stroke

A

MOST COMMON Type is THROMBOTIC!!!!!
2nd is embolic

MOST COMMON FOR TIA is emoblic

54
Q

anterior cerebral artery

A

greater in leg than upper extremity- personality changes, impaired judgement!

55
Q

posterior cerebral artery

A

visual hallucinations

56
Q

basillar artery

A

cerebellar dysfunction

57
Q

vertebral artery

A

vertigo, nystagmus, n/v diplopia

58
Q

ICH- intracranial

A

common by HTN!!!!- head elevation and IV mannitol, hyperventilation!!, lower only if 220/120
can be supportive or evacuation

59
Q

SAH

A

sudden worst h ache of life- n/v/
nuchal rigidenty
mc due to berry aneurysm or AVM
xanthochromia, lumbar puncture- clipping or coiilng of aneurysm

60
Q

epidural hemorrhage

A

ARTERIAL BLEED- between skull and DURA
MC after temporal bone fracture- middle meningeal artery!!!!
brief loc- lucid interval-coma, headache/n/v
CT: CONVEX (lens shaped)- does not cross - in temporal area!!!
hyper vent, mannitol, head elevation

61
Q

subdural hematoma

A

VENOUS BLEED!!!!- between dura and arachnoid- mostly in ELDERLY
blunt TRAUMA!
COncave- CRESCENT SHAPED BLEED!
bleed can cross suiure liens

62
Q

meningits

A

don’t wait for lumbar puncture to start empiric abx

glucose decreased, protein increased, pmn (in bacterial), increased CSF pressure

63
Q

less than 1 month meningitis

A

group B strep- agalactiae, or listeria

Ampicillin to cover listeria and cefotaxime

64
Q

1 month to 18 years

A

n. meninigits - s. pneumo-

ceftriaxone plus vanco

65
Q

18-50 years

A

strep mostlyl, or n.meningitis-

ceftriaxone plus vanco

66
Q

more than 50

A

s. pneumo, listeria

ampicillin, ceftriaxone and vanco

67
Q

prophylaxis for meningits

A

cipro or rifampin

68
Q

viral meningitis

A

most likely enterovirus - coxackie!!! or echovirus!!- no abonormal cerebral function
lymphocytosis, normal glucose
self limited

69
Q

encephalitis

A

mc due to hsv1
supprtive care,
comes with cerebral function dysfunction- lethargy, ams, focal neuroogic deficits
valcyclovir

70
Q

simple partial (Focla)

A

consiouss fully maintained-

71
Q

complex partial (Focal)

A

consciousness impaired

72
Q

generalized- absense

A

brief laspe of consciousness, staring episodes, eyelid twitching- NO POST ICTAL
achildhood
tx: ethosuximide

73
Q

generlaized-tonic clonic

A

tonic: loss of conscioussness rigidt
clonic: repetitive, rhytmic jerking
postictal: flaccid coma/sleep
aka grand mall: tx: depakote, phenytoin, caramazepine, lamotriegine

74
Q

generalized- myoclonus

A

sudden, brief, sporadic involuntary twitching, NO LOC- 1 muscl eor grup of muscles

75
Q

atonic

A

drop attacks- sudde nloss of posture tone

- generalized

76
Q

status epilepticus

A

seizure without recovery for more than 30 mins

ativan or valium , then phenytoin, and then last one would be phenobarbital!!!!

77
Q

myoclonus

A

depakote, klonopin

78
Q

febrile

A

phenobarbital

79
Q

phenytoin

A

gingival hyperplasai, SJS,

80
Q

depaktote se

A

pancreatitis, hepatotox

81
Q

benzo overdose

A

flumezenil to reverse sedation

82
Q

nerves

A

c5- biceps reflex

c6: brachioradialis reflex- wrist extension
c7: triceps jerk reflex
c8: finger flexion- motor

83
Q

neuroleptic malignant syndrome

A

decreased dopamine activity like haldol, chlorpromazine, risperidone
hyper salivation, inconvintence, hyperthermia, muscle ridig, parkinson type syndrome, HYPO reflexia
rhambdo!!- due to muscle tremors and rigidity

discontinue drug, supportive care, dopamine agonists (like bromo)

84
Q

serotonin syndrome

A

hyperthermia, tachy, agitated mood, HYPERREFLEXIA
dont mix seratonin with mao or st.john’s wort or promethazine!!
benzo for hyperthermia
seratonin antagonist: cryptohepadine

85
Q

glutamate

A

excitatory neurotransmitter in CNS- too many in azlhermiers - which then causes ecll death

86
Q

gaba

A

inhibitory trasnmistter in CNS- ETOH mimics GABA
decreased GABA in upper motor nueron lesiosn

benzo increases gaba

87
Q

acetylcholine

A

in parkinson’s = it is increased- due to depletion of dopamine
in alzhemier’s- it is decreased

88
Q

dopamine

A

inhbibitory cns transmittor- allows for corodinated movements
schizophrenia- increased dopamine!!!-
decreased in parkinson’s!

PANRE (18 decks)

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