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Family Medicine EOR > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the definitive diagnosis of Alzheimer’s disease?

A

Brain autopsy

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2
Q

MC type of dementia?

A

Alzheimer disease

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3
Q

What changes in the brain are seen in Alzheimers?

A

amyloid deposits (senile plaques) and neurofibrillary tangles (tau protein)

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4
Q

What is the mechanism of Alzheimer?

A

cholinergic deficiency

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5
Q

Treat of Alzheimer?

A

Cholinesterase inhibitors: Donepezil, Rivastigmine, and Galantamine

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6
Q

What drugs should be avoided in Alzheimer?

A

anti-cholinergics drugs (cough meds too)

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7
Q

What NMDA antagonist is used for mod-severe Alzheimer?

A

Memantine

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8
Q

What symptoms are seen in Alzheimer?

A

Short term memory loss (1st), long term, disorientation, behavioral and personality changes

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9
Q

Diagnosis for Alzheimer?

A

non-contrast CT or MRI

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10
Q

What is the mechanism of ach-esterase inhibitors?

A

prevent the breakdown of acetylcholine

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11
Q

What 4 medications are FDA approved for Alzheimers?

A

Tacrine
Donepezil (Aricept®, Aricept ODT)
Rivastigmine (Exelon®, Exelon patch)
Galantamine (Razadyne®, Razadyne ER)

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12
Q

What is the first symptom seen in Alzheimers?

A

anterograde amnesia

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13
Q

Treatment for delirium?

A

treat the cause

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14
Q

Whom is delirium mostly seen in?

A

hospitalized elderly pts

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15
Q

What type of hallucinations are the most common type experienced by patients with delirium?

A

Visual hallucinations

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16
Q

What is a typical antipsychotic commonly used for the treatment of delirium?

A

Haloperidol

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17
Q

What is the most common cause of delirium?

A

alcohol abuse

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18
Q

What is the treatment of choice for delirium tremens in alcohol withdrawal?

A

Benzodiazepines

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19
Q

“blind as a bat, hot as Hades, red as a beet, dry as a bone, mad as a hatter

A

Anticholinergic overdose

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20
Q

How does bell palsy look?

A

unilateral facial weakness/paralysis

both upper and lower parts of the face

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21
Q

What does Bell palsy forehead look like?

A

unable to lift affected eyebrow (wrinkle forehead)

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22
Q

Treatment for Bell palsy?

A

Txt is not required- most cases resolve 1mo
Prednisone- 1st 72hr of sx onset
Artificial tears
Acyclovir

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23
Q

MC side for Bell palsy?

A

right (60%)

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24
Q

Bell palsy has strong association with?

A

Herpes simplex virus reactivation

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25
Q

What nerve is affected in Bell palsy?

A

CN VII (7)

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26
Q

What is the pathogenesis of bell palsy?

A

inflammation or compression of CN VII

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27
Q

Bell palsy usually follows what?

A

a URI

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28
Q

What should Bell palsy pt wear at night to prevent corneal abrasion?

A

eye patch

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29
Q

A CVA blockage is ?

A

ischemic stroke

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30
Q

A CVA rupture of blood vessel is?

A

hemorrhagic stroke

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31
Q

Right sided symptoms=

A

left sided stroke

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32
Q

Left sided symptoms=

A

Right sided stroke

33
Q

Dx for CVA?

A

CT without contrast

34
Q

Txt for CVA?

A

IV tPA within 3-4.5 hrs of symptom onset

35
Q

Txt for CVA after 4.5 hours?

A

Intra-arterial thrombolysis up to 6hrs

36
Q

What is the most common artery affected in a ischemic stroke?

A

middle cerebral artery (anterior circulation)

37
Q

Most important modifiable risk factor of stroke?

A

HTN

38
Q

Primarily affects frontal lobe function, with legs>arms

A

Anterior cerebral artery occlusion

39
Q

Risk factors for Lacunar stroke?

A

diabetes and hypertension

40
Q

What is the mc cause of chronic severe disability?

A

stroke

41
Q

What should the blood pressure be maintained at for tPA?

A

<185/105

42
Q

Exclusion criteria for tPA use in strokes?

A 
suggest SAH
Head trauma or prior stroke within 3mo
MI within 3mo
GI or gastric ulcer hemorrhage within 21 days
Major surgery within 14days
Elevated BP >185/ 110
Active bleeding
Taking anticoagulants
43
Q

Extended exclusion criteria for tPA?

A 
Age  >80yrs
All pts taking oral antigcoagulants regardless of INR
Stroke scale > 25
Hx of stroke and diabetes
Oral aspirin
44
Q

What causes a essential tremor?

A

autosomal dominant inheritance

45
Q

Presentation of a essential tremor?

A

shaking with task, handwriting, or shaving, tremors with outstretched arms or performing movement WITHOUT resting component

46
Q

What makes essential tremors better?

A

alcohol

47
Q

What is the first line txt for essential tremor?

A

Propranolol or atenolol

48
Q

2nd and 3rd line txt for essential tremor?

A

Primidone (barbiturate)

Alprazolam (benzodiazepine)

49
Q

What makes essential tremors worse?

A

anxiety, fatigue, caffeine, or stimulants, drugs for asthma and emphysema

50
Q

Three cardinal features of Parkinson?

A

Rest (pill rolling), tremor, cogwheel rigidity, bradykinesia, shuffling gait

51
Q

Gold standard for Parkinson dx?

A

neuropathologic exam

52
Q

Txt for Parkinson < 65yr?

A

bromocriptine, pramipexole, ropinirole (dopamine agonist)

53
Q

Txt for Parkinson > 65yr?

A

Levodopa/carbidopa (Sinemet)

54
Q

What are sde of L-dopa?

A

GI upset w/ n/v, vivd dreams or nightmares, psychosis, and dyskinesias

55
Q

Mechanism of Parkinson?

A

idiopathic dopamine depletion, failure to inhibit Ach in the basal ganglia

56
Q

What is seen in brains of Parkinson pts?

A

lewy bodies, loss of pigment cells seen in substantia nigra

57
Q

T/F Parkinson tremor is present at rest?

A

True

58
Q

T/F essential tremor is absent at rest?

A

True

59
Q

What is a positive Myerson’s sign?

A

tapping the bridge of the nose causes sustained blink

60
Q

What is the most effective txt for Parkinson?

A

Levodopa/Carbidopa (Sinemet)

61
Q

Side effect of dopamine agonist?

A

orthostatic hypotension

62
Q

What are two additional treatment classes that can me used for Parkinson?

A

Monoamine oxidase type B inhibitors

Catechol-O-Methyltransferase COMT inhibitors

63
Q

What are focal seizures?

A

no alteration in consciousness

64
Q

What are complex partial seizures?

A

focal seizures with altered consciousness

65
Q

Abnormal movements or sensations?

A

Focal seizures (simple partial)

66
Q

Lip smacking, confusion and loss of memory

A

complex partial

67
Q

Treatment for focal seizures?

A

Phenytoin and carbamazepine

68
Q

What are absence (petit mal) seizures?

A

brief impairment of consciousness , most miss them

69
Q

What are tonic clonic seizures (grand mal)?

A

classic seizures with postictal phase: confused

70
Q

What are atonic seizures?

A

drop attacks, looks like syncope with loss of muscle tone

71
Q

Treatment for Absence Petit Mal seziures?

A

Ethosuximide

72
Q

Treatment for Status Epilepticus?

A

Lorazepam or Diazepam-> Phenytoin (Dilantin)-> Phenobarbital

73
Q

Treatment for Myoclonus seizures?

A

Valproic acid, Clonazepam

74
Q

What are sde of Phenytoin?

A

gingival hyperplasia, SJS, hirsutism

75
Q

What is the diagnosis of seizures?

A

EEG

76
Q

What are the sde of Valproic acid?

A

pancreatitis, heptotoxicity

77
Q

What are the sde of benzo?

A

sedation

78
Q

MC cause of syncope?

A

Vasovagal syncope

Family Medicine EOR (15 decks)

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