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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
MS
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!!!
26
DX of Multiple SCLEROSIS
MRI- WHITE matter plaques!!!!!!! lumbar puncture: iGG oligoclonal bands in CSF ACUTE: IV corticosteroids and plasmapheriesis!!! relapse-remitting: b interferron or glatiramere acetate
27
bells palsy
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!!!!
28
tension headaches
bilateral tight, band like vise like no nausea, vomiting or focal neurologic symptoms NSAIDS, Aspiprin, acetaminophen, ELAVIL prophylaxis;: beta blockers
29
migraine headaches
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!!
30
tx for migraines
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
31
Trigeminal neuralgia
brief, episodic, stabbing/lancinated pain- worse with touch, eating, drafts of wind and movements- often UNLITERLA! CARBAMAZEPINE!!!!!
32
cluster headache
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
33
pseudotuor cerebri
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!!!!!
34
normal pressure hydrocephalus
``` normal opening pressure on lumbar puncture- but dilation of the cerebral ventricles DEMENTIA GAIT DISTURBANCE URINARY INCONTINENCE!!!! ventriculoperitnieal shunt- tx ```
35
concussion
mild traumatic brain injury- alteration in mental status confusion, amnesia ehadache, dizzines,s visual, emotional instability, vomiting ct scan cognitive and physical rest: tx
36
delirium
transient confused state, rapid onset, fluncuating mental status change, SHORT TERM MEMORY !
37
dementia
``` chronic intellectual deterioration- memory loss and loss of impulse control!!! alzehimer's vascular frontotemporal diffuse lewy body ```
38
alzheimemrs
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
vascular dementia
lacunar infarcts- htn - 2nd most common
40
front to temporal
picks disease- brain gdegenration- marked personality changes!!!!!
41
diffuse lewy body
visual hallucinations, delusions!!
42
astorcytoma
pilocytic astrocrytoma- grade I- most benign- mc in children and young adults GRADE IV= glioblastoma-multiforme- mc primary cns tumors in ddauldts
43
glioblastoma multiforme
most caggressive of all the primary cns tumors in adults!! | cushings reflex: irregular respiratoions, htn, brady
44
meningiomas
usually BENIGN Tumors!! associated with neurofibromatoisis NF 2 attached to the dura spindle cells
45
atlast c1 burst fracture
jefferson!!!!
46
hangmans'
c2!!!! may lead to sponyloslisthesis between c2 and c3
47
cords
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
non dominant side
usually right hemisphere: contralateral left hemiparesis, left neglect, apraxia: purposely movements can't be done, flat affect, impaired judgement, impulsev
49
dominant side lesisons
usually the left hemisphere: right hemiparesis, right sensory loss, aphsia (can't remember words), agraphia , decreased math compresnsions
50
TIA
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
lacunar
small vessel disease- pure motor mc, dysarthria, HISTORY OF HTN!!!!
52
mmiddle cerebral artery (MOST COMMONLY AFFECTED BY ISCHEMIC STROKE)
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
ischemic stroke
MOST COMMON Type is THROMBOTIC!!!!! 2nd is embolic MOST COMMON FOR TIA is emoblic
54
anterior cerebral artery
greater in leg than upper extremity- personality changes, impaired judgement!
55
posterior cerebral artery
visual hallucinations
56
basillar artery
cerebellar dysfunction
57
vertebral artery
vertigo, nystagmus, n/v diplopia
58
ICH- intracranial
common by HTN!!!!- head elevation and IV mannitol, hyperventilation!!, lower only if 220/120 can be supportive or evacuation
59
SAH
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
epidural hemorrhage
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
subdural hematoma
VENOUS BLEED!!!!- between dura and arachnoid- mostly in ELDERLY blunt TRAUMA! COncave- CRESCENT SHAPED BLEED! bleed can cross suiure liens
62
meningits
don't wait for lumbar puncture to start empiric abx | glucose decreased, protein increased, pmn (in bacterial), increased CSF pressure
63
less than 1 month meningitis
group B strep- agalactiae, or listeria | Ampicillin to cover listeria and cefotaxime
64
1 month to 18 years
n. meninigits - s. pneumo- | ceftriaxone plus vanco
65
18-50 years
strep mostlyl, or n.meningitis- | ceftriaxone plus vanco
66
more than 50
s. pneumo, listeria | ampicillin, ceftriaxone and vanco
67
prophylaxis for meningits
cipro or rifampin
68
viral meningitis
most likely enterovirus - coxackie!!! or echovirus!!- no abonormal cerebral function lymphocytosis, normal glucose self limited
69
encephalitis
mc due to hsv1 supprtive care, comes with cerebral function dysfunction- lethargy, ams, focal neuroogic deficits valcyclovir
70
simple partial (Focla)
consiouss fully maintained-
71
complex partial (Focal)
consciousness impaired
72
generalized- absense
brief laspe of consciousness, staring episodes, eyelid twitching- NO POST ICTAL achildhood tx: ethosuximide
73
generlaized-tonic clonic
tonic: loss of conscioussness rigidt clonic: repetitive, rhytmic jerking postictal: flaccid coma/sleep aka grand mall: tx: depakote, phenytoin, caramazepine, lamotriegine
74
generalized- myoclonus
sudden, brief, sporadic involuntary twitching, NO LOC- 1 muscl eor grup of muscles
75
atonic
drop attacks- sudde nloss of posture tone | - generalized
76
status epilepticus
seizure without recovery for more than 30 mins | ativan or valium , then phenytoin, and then last one would be phenobarbital!!!!
77
myoclonus
depakote, klonopin
78
febrile
phenobarbital
79
phenytoin
gingival hyperplasai, SJS,
80
depaktote se
pancreatitis, hepatotox
81
benzo overdose
flumezenil to reverse sedation
82
nerves
c5- biceps reflex c6: brachioradialis reflex- wrist extension c7: triceps jerk reflex c8: finger flexion- motor
83
neuroleptic malignant syndrome
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
serotonin syndrome
hyperthermia, tachy, agitated mood, HYPERREFLEXIA dont mix seratonin with mao or st.john's wort or promethazine!! benzo for hyperthermia seratonin antagonist: cryptohepadine
85
glutamate
excitatory neurotransmitter in CNS- too many in azlhermiers - which then causes ecll death
86
gaba
inhibitory trasnmistter in CNS- ETOH mimics GABA decreased GABA in upper motor nueron lesiosn benzo increases gaba
87
acetylcholine
in parkinson's = it is increased- due to depletion of dopamine in alzhemier's- it is decreased
88
dopamine
inhbibitory cns transmittor- allows for corodinated movements schizophrenia- increased dopamine!!!- decreased in parkinson's!

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