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PGY-4 Board Prep > Neurology > Flashcards

Neurology Flashcards

1
Q

Treatment of Cluster Headaches

A

sumatriptan or 100% HFNC

prophylaxis w/ verapamil

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2
Q

TIA - Treatment if extracranial stenosis is present

A

> 70% treatment recommended

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3
Q

Ischemic Stroke - Types

A

Thrombotic/large artery atherosclerosis
Cardioembolic
Small subcortical infarcts
Cryptogenic/other

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4
Q

Treatment of Ischemic Strokes

A

TPA w/in 3 hours

Aspirin

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5
Q

HTN following strokes

A

for TPA, <185/110
for no TPA, <220/120
for ICH: <160/90

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6
Q

BP for ischemic strokes not treated with TPA

A

no treatment unless less than 220/120 or end organ dysfunction

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7
Q

Hemorrhagic Strokes - Types

A

Subarachnoid Hemorrhages

Intracerebral Hemorrhage

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8
Q

Treatment of SAH

A

surgery if possible
Nimodipine for vasopasm
BP <160/110
reverse anticoagulation

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9
Q

Intracerebral Hemorrhage - Causes

A

HTN

consider cerebral amyloidosis in older adults (>55)

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10
Q

Primary Prevention for Strokes

A
  • modify RF (HTN, smoking)
  • statin
  • stenosis or aneurysm treatment if necessary
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11
Q

Arterial Stenosis & Strokes

A

Immediate Period: Extracranial stenosis > 70%

Symptomatic intracranial >70% for secondary prevention

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12
Q

Secondary Prevention for Strokes

A

Aspirin
Statin
BP <130/80

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13
Q

Mononeuritis Multiplex

A

commonly presents as foot or wrist drop

can be sign of EGPA (Churg-Strauss)

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14
Q

POUND

A

pulsatile, onset less than 24 hours, unilateral, N/V, disabling; 3 predictive

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15
Q

Status Migranosus duration

A

72 hours

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16
Q

Status migranosus treatment

A

steroids, DHE/dopamine antagonist

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17
Q

When to start migraine treatment

A

at least 5 a month

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18
Q

Chronic migraine defined as

A

15 or more days per month

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19
Q

Contraindications for triptan use

A

coronary, cerebral or peripheral vascular disease
uncontrolled HTN
migraine w/ brainstem or hemiplegic auras

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20
Q

Duration of Cluster Headaches

A

15-180 minutes

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21
Q

CPH (chronic paroxysmal hemicrania)

A

2-30 minutes

Rx w/ indomethacin

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22
Q

SUNCT (short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing)

A

1-600 seconds, Rx w/ lamotrigine

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23
Q

Trigeminal Neuralgia

A

V2 (maxillary) and V3 (mandibular) branches of facial nerve
association w/ MS
Rx w/ carbamazepine

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24
Q

Monitoring of pts when on carbamazepine

A

hyponatremia

agranulocytosis

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25
Q

Medication Overuse Headache Definition

A

headache >15 days per month with medication use >10 days per month

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26
Q

Cough Variant HA

A

order mri to r/o chiari malformation

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27
Q

Thunderclap Headache

A

maximum intensity w/in 1 minute

think SAH

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28
Q

SAH diagnosis

A

CT then LP

LP - xanthochromia, RBC >10,000

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29
Q

SAH cause

A

saccular aneurysm

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30
Q

SAH treatments

A

NS

nimodipine to help prevent later vasospasm

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31
Q

Reversible Cerebral Vasoconstriction Syndrome

A 
thunderclap HA that reoccurs
often cause (pregnancy, vasoactive drug)
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32
Q

RCVS Treatment

A

Nimodipine or Verapamil

Normalize BP, avoid exercise

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33
Q

Concussion Grades

A

1, no LOC or amnesia, <15 minutes AMS
2, no LOC, amnesia & AMS >15 minutes
3 - LOC

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34
Q

Basilar Fracture Signs

A

hemotympanum
orbital ecchymoses
mastoid ehhymoses (Battle Sign)

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35
Q

TBI headaches should resolve in

A

7-10 days

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36
Q

Epidural Hematoma

A

fracture of temporal bone
laceration of middle meningeal artery
lentiform fashion, between dura mater and skull

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37
Q

Subdural Hematoma

A

injury to bridging veins between cortex and dura

crescent shape

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38
Q

Primary CNS Lymphoma risk factor

A

immunodeficiency

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39
Q

Primary CNS Lymphoma and most common type

A

NHL/diffuse large B cell lymphoma

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40
Q

Primary CNS Lymphoma & Steroids

A

avoid unless increased ICP, can suppress lymphoma and delay diagnosis/biopsy

41
Q

GBM imaging

A

large, space occupying lesion with central necrosis, mass effect, surrounding edema

42
Q

GBM treatment

A

resection if possible + chemo + radiation

43
Q

Meningioma on imaging

A

dural based lesion, often with smooth round shape a tail that tracks along dura

44
Q

Meningioma on imaging

A

dural based lesion, often with smooth round shape a tail that tracks along dura

45
Q

Most common brain metastases

A

lung, breast, kidney, melanoma

46
Q

Cognitive Impairment Required Workup by American Neurological Association

A 
CBC, BMP
TSH, Vit B12
RPR
CT or MRI
Vitamin D
47
Q

Alzheimer Disease Treatment

A 
Cholinesterase inhibitors (donepezil)
Moderate-severe: memantine
48
Q

Definition of Epilepsy

A

two unprovoked seizures more than 24 hours apart

one unprovoked seizure with risk of further seizures

49
Q

Work up for first time seizures

A

EEG, MRI

50
Q

AEDs in young women

A

lamotrigine or levetiracetam

51
Q

Intractable Epilepsy Definition

A

without seizure freedom despite 1 year of treatment with TWO appropriately dosed AEDs

52
Q

Treatment of Status

A

1- IV benzo
2- AED: Fosphenytoin
3: intubation/anesthetic

53
Q

ABCD Score & Hospitalization

A

greater than 3

54
Q

Antiplatelet/Anticoagulation after strokes

A

ASA
if A fib - warfarin
if PAD - plavix

55
Q

Start AEDs after first seizure if

A

> 65

head trauma

56
Q

Lamotrigine & OCP

A

dose needs to be increased

57
Q

Parkinson Disease - 4 features

A

resting tremor (unilateral)
bradykinesia
cogwheel rigidity
gait/postural impairemnt

58
Q

PD treatment (two age groups)

A

<65: dopamine agonists including pramipexole & ropinirole
>65 levodopa+cardopa

59
Q

Mild PD treatment

A

selegiline/MAOI

amantadine

60
Q

Dopamine Therapy in PD AEs

A

motor fluctuations (wearing off) and dyskinesia

61
Q

PD + multiple system atrophy

A

prominent dysautonomia (diarrhea, urinary incontinence, orthostatic hypotension)

62
Q

Essential Tremor

A

BL UE postural and action tremor

better w/ ETOH

63
Q

Enhanced Physiologic Tremor

A

due to caffeine, meds, anxiety; resolves with removal of stressor

64
Q

Essential Tremor diagnosis - labs

A

Wilson disease, TSH

65
Q

Essential Tremor treatment

A

propranolol or primidone

66
Q

McArdle Disease

A

glycogen storage disease V
myophophorlyase def
myopathy w/ exercise

67
Q

Dystonia Rx/Diagnosis

A

trial of levodopa to screen for dopamine responsive dystonia
screen for Wilson disease
anti-cholinergic agents

68
Q

Tourette Dx

A

motor + vocal for at least 1 year

69
Q

Tic Rx

A

clonidine, guanfacine, topiramate, keppra

70
Q

Neuroleptic Malignant Syndrome

A 
caused by dopamine blocking agents
fever, rhabdo, AMS, rigidity
Rx dantrolene (not great)
71
Q

Uhthoff phenomenon

A

transient worsening of MS symptoms due to hot weather, physical exertion or fever
“pseudorelapse”

72
Q

Tourette Dx

A

motor + vocal for at least 1 year

73
Q

ADEM, differentiation from MS

A

fevers + encephalopathy

74
Q

MS - lifestyle factors

A

smoking cessation
Vitamin D supplementation
exercise
vaccines

75
Q

Uhthoff phenomenon

A

transient worsening of MS symptoms due to hot weather, physical exertion or fever
“pseudorelapse”

76
Q

MS - LP findings

A

oligoclonal bands

elevated IgG

77
Q

ADEM, differentiation from MS

A

fevers + encephalopathy

78
Q

Ocrelizumab

A

primary progressive MS

79
Q

MS exacerbation

A

at least 24 hours

treat w/ steroids

80
Q

EMG, demyelinating vs axonal

A

demyelinating: velocity of nerve conduction decreases
axonal: velocity remains unchanged

81
Q

Natalizumab AE

A

MS medication, 2nd line

PML

82
Q

Ocrelizumab

A

primary progressive MS

83
Q

Miller Fischer Variant

A

ataxia, cranial neuropathies

antibodies to GQ1b ganglioside protein

84
Q

Amyotrophic lateral sclerosis

A

motor function
degeneration of motor neurons
upper + lower motor neuron symptoms

85
Q

GBS treatment

A

plasmapheresis, IVIG

no steroids

86
Q

Lower Motor Neuron Symptoms

A

atrophy

fasciculation

87
Q

Miller Fischer Variant

A

ataxia, cranial neuropathies

antibodies to GQ1b ganglioside protein

88
Q

Amyotrophic lateral sclerosis

A

motor function

degeneration of motor neurons

89
Q

Myasthenia Gravis Symptoms

A

ptosis, diplopia

90
Q

Myasthenia Gravis Rx

A

pyridostigmine (cholinesterase inhibitory)

steroids, immunosuppression

91
Q

Myasthenia Gravis Exacerbation Rx

A

IVIG or plasmapharesis

92
Q

Lambert Eaton Myasthenic Syndrome

A

antibodies against voltage gated calcium channel
Mg symptoms but weakness improves with exercise
hyporeflexia + dysautonomia
maliginacy, esp small cell lung cancer

93
Q

Myasthenia Gravis Symptoms

A

ptosis, diplopia

94
Q

Myasthenia Gravis Rx

A

pyridostigmine (cholinesterase inhibitory)

steroids, immunosuppressions

95
Q

Myasthenia Gravis Exacerbation Rx

A

IVIG or plasmapharesis

96
Q

Lambert Eaton Myasthenic Syndrome

A

antibodies against voltage gated calcium channel
Mg symptoms but weakness improves with exercise
hyporeflexia + dysautonomia
maliginacy, esp small cell lung cancer

97
Q

ICH BP treatment

A

less than 220/120
labetalol or nicardipine
avoid nitrates, potential to increase ICP

98
Q

Contraindictions for Donepezil

A

bradycardia, sick sinus syndrome
angle-closure glaucoma
uncontrolled asthma

99
Q

Bell’s Palsy

A

facial paralysis involving UPPER and LOWER parts of face

PGY-4 Board Prep (18 decks)

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