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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
Medication Overuse Headache Definition
headache >15 days per month with medication use >10 days per month
26
Cough Variant HA
order mri to r/o chiari malformation
27
Thunderclap Headache
maximum intensity w/in 1 minute | think SAH
28
SAH diagnosis
CT then LP | LP - xanthochromia, RBC >10,000
29
SAH cause
saccular aneurysm
30
SAH treatments
NS | nimodipine to help prevent later vasospasm
31
Reversible Cerebral Vasoconstriction Syndrome
``` thunderclap HA that reoccurs often cause (pregnancy, vasoactive drug) ```
32
RCVS Treatment
Nimodipine or Verapamil | Normalize BP, avoid exercise
33
Concussion Grades
1, no LOC or amnesia, <15 minutes AMS 2, no LOC, amnesia & AMS >15 minutes 3 - LOC
34
Basilar Fracture Signs
hemotympanum orbital ecchymoses mastoid ehhymoses (Battle Sign)
35
TBI headaches should resolve in
7-10 days
36
Epidural Hematoma
fracture of temporal bone laceration of middle meningeal artery lentiform fashion, between dura mater and skull
37
Subdural Hematoma
injury to bridging veins between cortex and dura | crescent shape
38
Primary CNS Lymphoma risk factor
immunodeficiency
39
Primary CNS Lymphoma and most common type
NHL/diffuse large B cell lymphoma
40
Primary CNS Lymphoma & Steroids
avoid unless increased ICP, can suppress lymphoma and delay diagnosis/biopsy
41
GBM imaging
large, space occupying lesion with central necrosis, mass effect, surrounding edema
42
GBM treatment
resection if possible + chemo + radiation
43
Meningioma on imaging
dural based lesion, often with smooth round shape a tail that tracks along dura
44
Meningioma on imaging
dural based lesion, often with smooth round shape a tail that tracks along dura
45
Most common brain metastases
lung, breast, kidney, melanoma
46
Cognitive Impairment Required Workup by American Neurological Association
``` CBC, BMP TSH, Vit B12 RPR CT or MRI Vitamin D ```
47
Alzheimer Disease Treatment
``` Cholinesterase inhibitors (donepezil) Moderate-severe: memantine ```
48
Definition of Epilepsy
two unprovoked seizures more than 24 hours apart | one unprovoked seizure with risk of further seizures
49
Work up for first time seizures
EEG, MRI
50
AEDs in young women
lamotrigine or levetiracetam
51
Intractable Epilepsy Definition
without seizure freedom despite 1 year of treatment with TWO appropriately dosed AEDs
52
Treatment of Status
1- IV benzo 2- AED: Fosphenytoin 3: intubation/anesthetic
53
ABCD Score & Hospitalization
greater than 3
54
Antiplatelet/Anticoagulation after strokes
ASA if A fib - warfarin if PAD - plavix
55
Start AEDs after first seizure if
>65 | head trauma
56
Lamotrigine & OCP
dose needs to be increased
57
Parkinson Disease - 4 features
resting tremor (unilateral) bradykinesia cogwheel rigidity gait/postural impairemnt
58
PD treatment (two age groups)
<65: dopamine agonists including pramipexole & ropinirole >65 levodopa+cardopa
59
Mild PD treatment
selegiline/MAOI | amantadine
60
Dopamine Therapy in PD AEs
motor fluctuations (wearing off) and dyskinesia
61
PD + multiple system atrophy
prominent dysautonomia (diarrhea, urinary incontinence, orthostatic hypotension)
62
Essential Tremor
BL UE postural and action tremor | better w/ ETOH
63
Enhanced Physiologic Tremor
due to caffeine, meds, anxiety; resolves with removal of stressor
64
Essential Tremor diagnosis - labs
Wilson disease, TSH
65
Essential Tremor treatment
propranolol or primidone
66
McArdle Disease
glycogen storage disease V myophophorlyase def myopathy w/ exercise
67
Dystonia Rx/Diagnosis
trial of levodopa to screen for dopamine responsive dystonia screen for Wilson disease anti-cholinergic agents
68
Tourette Dx
motor + vocal for at least 1 year
69
Tic Rx
clonidine, guanfacine, topiramate, keppra
70
Neuroleptic Malignant Syndrome
``` caused by dopamine blocking agents fever, rhabdo, AMS, rigidity Rx dantrolene (not great) ```
71
Uhthoff phenomenon
transient worsening of MS symptoms due to hot weather, physical exertion or fever "pseudorelapse"
72
Tourette Dx
motor + vocal for at least 1 year
73
ADEM, differentiation from MS
fevers + encephalopathy
74
MS - lifestyle factors
smoking cessation Vitamin D supplementation exercise vaccines
75
Uhthoff phenomenon
transient worsening of MS symptoms due to hot weather, physical exertion or fever "pseudorelapse"
76
MS - LP findings
oligoclonal bands | elevated IgG
77
ADEM, differentiation from MS
fevers + encephalopathy
78
Ocrelizumab
primary progressive MS
79
MS exacerbation
at least 24 hours | treat w/ steroids
80
EMG, demyelinating vs axonal
demyelinating: velocity of nerve conduction decreases axonal: velocity remains unchanged
81
Natalizumab AE
MS medication, 2nd line | PML
82
Ocrelizumab
primary progressive MS
83
Miller Fischer Variant
ataxia, cranial neuropathies | antibodies to GQ1b ganglioside protein
84
Amyotrophic lateral sclerosis
motor function degeneration of motor neurons upper + lower motor neuron symptoms
85
GBS treatment
plasmapheresis, IVIG | no steroids
86
Lower Motor Neuron Symptoms
atrophy | fasciculation
87
Miller Fischer Variant
ataxia, cranial neuropathies | antibodies to GQ1b ganglioside protein
88
Amyotrophic lateral sclerosis
motor function | degeneration of motor neurons
89
Myasthenia Gravis Symptoms
ptosis, diplopia
90
Myasthenia Gravis Rx
pyridostigmine (cholinesterase inhibitory) | steroids, immunosuppression
91
Myasthenia Gravis Exacerbation Rx
IVIG or plasmapharesis
92
Lambert Eaton Myasthenic Syndrome
antibodies against voltage gated calcium channel Mg symptoms but weakness improves with exercise hyporeflexia + dysautonomia maliginacy, esp small cell lung cancer
93
Myasthenia Gravis Symptoms
ptosis, diplopia
94
Myasthenia Gravis Rx
pyridostigmine (cholinesterase inhibitory) | steroids, immunosuppressions
95
Myasthenia Gravis Exacerbation Rx
IVIG or plasmapharesis
96
Lambert Eaton Myasthenic Syndrome
antibodies against voltage gated calcium channel Mg symptoms but weakness improves with exercise hyporeflexia + dysautonomia maliginacy, esp small cell lung cancer
97
ICH BP treatment
less than 220/120 labetalol or nicardipine avoid nitrates, potential to increase ICP
98
Contraindictions for Donepezil
bradycardia, sick sinus syndrome angle-closure glaucoma uncontrolled asthma
99
Bell's Palsy
facial paralysis involving UPPER and LOWER parts of face

PGY-4 Board Prep (18 decks)

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