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Internal Med PAEA > Neurology > Flashcards

Neurology Flashcards

1
Q

What type of genetic disorder is Huntington disease?

A

Autosomal dominant

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2
Q

What is the patho of Huntington disease?

A

trinucleotide repeats (CAG/glutamine) of the Huntington gene (chromo 4)

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3
Q

What age does Huntington disease usually appear?

A

30-50yr

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4
Q

What are the 3 classic signs of Huntington disease?

A

progressive chorea, rigidity, and dementia, frequently associated with seizures.

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5
Q

How is Huntington dx diagnosed?

A

sx + family hx+ genetic confirmation

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6
Q

What is seen on imaging for Huntington dx?

A

cerebral & striatal (caudate nucleus & putamen) atrophy

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7
Q

Txt for Huntington dx?

A

None, fatal in 15-20yr, genetic counseling

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8
Q

1st FDA approved txt for chorea associated with Huntington dx?

A

Tetrabenazine

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9
Q

MC cause of primary headaches?

A

tension headaches

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10
Q

Bilateral, pressing, tightening “band like” non-throbbing headache?

A

tension headache

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11
Q

What is seen on PE for tension headaches?

A

pericranial muscle tenderness to the head, neck, or shoulders

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12
Q

Tx for tension headache?

A

NSAIDS

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13
Q

Dx of tension headaches?

A

clinical

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14
Q

severe, unilateral periorbital or temporal pain headache?

A

cluster headache

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15
Q

What can trigger a cluster headache?

A

alcohol, stress, specific foods

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16
Q

When are cluster headaches worse?

A

at night

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17
Q

Horner’s syndrome?

A

ptosis, miosis, anhidrosis

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18
Q

What is seen on PE for cluster headaches?

A

horner’s syndrome, nasal congestion, rhinorrhea, conjunctivitis, lacrimation

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19
Q

1st line txt for cluster headache?

A

100% oxygen followed by anti-migraine meds

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20
Q

1st line prophylaxis for cluster headaches?

A

Verapamil

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21
Q

What is the MC type of migraine?

A

migraine without aura

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22
Q

What type of focal neurologic symptoms is the most common type during a migraine?

A

visual

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23
Q

When should a CT be used to dx migraine?

A
  • onset of migraine > 50y
  • first or worse severe headache
  • new daily, persistent headache
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24
Q

1st line txt for migraine?

A

NSAIDS, Acetaminophen, Aspirin

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25
Q

What can be added to improve meds during migraines?

A

caffeine

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26
Q

2nd line txt for migraines?

A

Triptans or Ergotamines

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27
Q

Prophylactic txt for migraines?

A

anti-hypertensives = BB and CCB

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28
Q

C/I to triptans?

A

ischemic stroke, heart dx, uncontrolled hypertension, pregnancy

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29
Q

Adv event of triptans?

A

chest tightness from vasoconstriction

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30
Q

Adv event of ergotamines?

A

rebound headache

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31
Q

Used for abortive migraine therapy?

A

IV Metoclopramide

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32
Q

What nerve does bell palsy affect?

A

VII

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33
Q

What is bell palsy closely related too?

A

Herpes simplex virus reactivation

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34
Q

What sx are seen in bell palsy?

A

Ear pain, unilateral facial weakness, taste disturbance, inability to completely close eyelid

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35
Q

Txt for Bell palsy?

A

Supportive- eye drops
Prednisone
Acyclovir

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36
Q

What txt for bell palsy should be given within the first 72hrs to decrease recovery time?

A

Prednisone

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37
Q

When used in combination can in severe cases can improve symptoms and timing of recovery of bell palsy?

A

Acyclovir and glucocorticoids

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38
Q

In bell palsy weakness and paralysis only affects?

A

The face

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39
Q

What is the MC cause of Gillian barre?

A

Campylobacter jejuni

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40
Q

What is gullain barre syndrome?

A

Demyelination polyradiculopathy of the peripheral nervous system

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41
Q

Sx of guillain barre?

A

Symmetric ascending weakness and sensory changes

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42
Q

What is a life threatening symptom of guillain barre?

A

Weakness of respiratory muscles

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43
Q

Sx of guillan barre?

A

Nerve conduction studies

CSF analysis

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44
Q

What is seen on CSF for Guillain barre?

A

High protein
Normal WBC
Normal glucose

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45
Q

Txt for Guillain Barre?

A

Plasmapheresis or IVIG

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46
Q

What txt should not be used for Guillan Barre?

A

Prednisone

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47
Q

What is the prognosis for Guillan Barre?

A

60% full recovery in 1yr

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48
Q

What is MS?

A

autoimmune, inflammatory demyelinating disease of the CNS

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49
Q

What axon degeneration does MS affect?

A

white matter (brain & spinal cord)

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50
Q

What type of MS is the MC?

A

relapsing-remitting

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51
Q

What is the MC presenting symptoms of MS?

A

weakness and visual disturbances

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52
Q

What visual disturbances are seen in MS?

A

diplopia, optic neuritic

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53
Q

What is Uhthoff’s phenomenon?

A

worsening of symptoms w/ heat

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54
Q

What is Lhermitte’s sign?

A

neck flexion causes lightning shock type pain radiating from the spine down the leg

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55
Q

The best initial and accurate test for MS?

A

MRI w/ gadolinium (contrast)

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56
Q

What proof is needed to dx MS?

A

2 areas of white matter involvement

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57
Q

If MRI is inconclusive what other test can be used to dx MS?

A

Lumbar puncture

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58
Q

What is seen on lumbar puncture for MS?

A

increased IgG & oligoclonal bands

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59
Q

1st line txt for MS?

A

IV glucocorticoids

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60
Q

Prevention of MS?

A

Beta-interferon or Glatiramer

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61
Q

What vitamin deficiency puts you at risk for MS?

A

Vitamin D

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62
Q

Patho of Myasthenia gravis?

A

autoantibodies against acetylcholine postsynaptic receptor at the neuromuscular junction

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63
Q

2 main symptoms of Myasthenia gravis?

A

ocular weakness

generalized weakness

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64
Q

Weakness is worsened with repeated muscle use and throughout the day with activties?

A

Myasthenia gravis

65
Q

What is myasthenia crisis?

A

respiratory muscle weakness

66
Q

What is the outpatient dx of myasthenia gravis?

A

acetylcholine receptor antibodies

67
Q

What is the most accurate outpatient test for myasthenia gravis?

A

electrophysiology testing

68
Q

What is the dx for emergent myasthenia gravis?

A

Edrophonium (Tensilon) test- brief improvement of sx

Ice pack test

69
Q

What is the long term txt for myasthenia gravis?

A

Acetylcholinesterase inhibitors: Pyridostigmine or Neostigmine

70
Q

What is the txt for myasthenia crisis?

A

Plasmapheresis or IVIG

71
Q

Possible curative txt of myasthenia gravis?

A

thymectomy

72
Q

What is parkinson disease?

A

idiopathic loss of dopaminergic neurons in the substantia nigra.

73
Q

Triad of symptoms seen in Parkinson disease?

A

resting tremor, bradykinesia, muscle rigidity

74
Q

What is the 1st symptom of Parkinson dx?

A

resting tremor

75
Q

Dx of Parkinson?

A

autopsy, lewy bodies and loss of pigment cells in the substantia nigra

76
Q

Most effective txt for Parkinson?

A

Levodopa- carbidopa

77
Q

1st line txt for pts < 65yr with Parkinson?

A

dopamine agonists- Bromocriptine

78
Q

What is the role of Carbidopa?

A

reduces the amount of Levodopa needed, keeps it from being being metabolized in the gut, liver and other tissue

79
Q

What should be used in monotherapy for patients with Parkinson with tremor as a predominant symptom?

A

anticholinergics- Trihexylphenidly, Benztropine

80
Q

What virus is associated with encephalitis?

A

Herpes simplex virus-1

81
Q

What symptoms are seen in encephalitis?

A

headache, neck stiffness, photosensitivity, fever, seizures, altered mental status

82
Q

What symptoms distinguishes encephalitis from aseptic meningitis?

A

altered mental status

83
Q

Dx of encephalitis?

A

CT first, then lumbar puncture

84
Q

What is seen on lumbar puncture for encephalitis?

A

increased lymphocytes, normal glucose

85
Q

What part of the brain is usually affected in encephalitis?

A

temporal

86
Q

The most accurate test for herpes encephalitis?

A

PCR

87
Q

Txt for HSV encephalitis?

A

IV acyclovir

88
Q

DOC of concussion?

A

CT head without contrast

89
Q

DOC for prolonged symptoms of a concussion?

A

MRI

90
Q

Txt for concussion?

A

cognitive and physical rest

91
Q

How long should pts be watched after a concussion?

A

min of 24hrs

92
Q

When can a person resume strenuous activities after a concussion?

A

upon resolution of symptoms and recovery of memory as well as cognitive functions

93
Q

When can a athletic return to play after a concussion?

A

We recommend that athletes NOT return to play the same day after concussion, and also that athletes NOT return to play until asymptomatic off medication

94
Q

What type of genetic disorder is essential tremor?

A

autosomal dominant

95
Q

What type of tremor is seen in essential tremor?

A

postural bilateral action tremor

96
Q

What part of the body does essential tremor affect?

A

upper extremities and head

97
Q

Tremor that is worsened with intentional movement and emotional stress?

A

essential tremor

98
Q

What tremor is improved w/ alcohol?

A

essentital tremor

99
Q

Dx of essential tremor?

A

exclusion, family hx

100
Q

Txt for essential tremor?

A

only txt if it interferes

101
Q

Txt for severe or situational essential tremor?

A

Propranolol

102
Q

2nd txt for essential tremor?

A

Primidone

103
Q

Initial dx of transient ischemic attack?

A

CT scan

104
Q

Definitive dx of transient ischemic attack?

A

conventional angiography

105
Q

Txt for non-cardiogenic TIA?

A

Antiplatelet therapy- aspirin, clopidogrel

106
Q

Txt for internal carotid artery stenosis 50-99%?

A

carotid endarterectomy

107
Q

Txt for cardiogenic artery stenosis?

A

oral anticoagulation

108
Q

What is a focal partial seizure?

A

one discrete part of the brain
simple- w consciousness
complex- w/o consciousness

109
Q

MC childhood seizure?

A

Absence Petit mal

110
Q

What is seen on EEG for absence seizures?

A

bilateral symmetric 3 Hertz spike and wave activity

111
Q

Txt for absence seizures?

A

Ethosuximide

112
Q

Second line txt for absence seizures?

A

Valproic acid

113
Q

Txt for generalized grand mal seizures?

A

Levetiracetam

114
Q

Txt for status epliepticus?

A

Benzo (Lorazepam)

115
Q

Second line tx for status epliepticus?

A

Phenytoin or Fosphenytoin

116
Q

Third line txt for status epliepticus?

A

Phenobarbital

117
Q

Definitive txt for status epilepticus if no meds work?

A

general anesthesia

118
Q

Giant cell arteritis has a similar clinical spectrum too?

A

polymyalgia rheumatica

119
Q

Sx of giant cell arteritis?

A

headache, jaw claudication, visual changes, scalp tenderness

120
Q

Definitive dx for giant cell arteritis?

A

temporal biospy

121
Q

Txt for giant cell arteritis?

A

high dose corticosteroids

122
Q

MC complication of giant cell arteritis?

A

blindness

123
Q

What is use to monitor txt effectivity in giant cell arteritis?

A

sedimentation rate

124
Q

Sx of deliruim?

A

fluctuating mental status changes and marked deficit in short term memory

125
Q

Three patho of alzheimer dx?

A

beta-amyloid plaques
neurofibrillary tangles
acetylcholine deficiency

126
Q

What is the 1st sx in dementia?

A

short term memory loss

127
Q

Dx of dementia?

A

r/o, MRI

128
Q

Txt of dementia?

A

acetylcholinesterase inhibitors-Donepezil, Tacrine, Rivastigmine, Galantamine

129
Q

Best add on drug for dementia?

A

Memantine

130
Q

MC and most aggressive primary malignant CNS tumors in adults?

A

Glioblastoma multiforme

131
Q

DOC for brain tumors?

A

MRI w/ contrast

132
Q

Txt for brain tumors?

A

excision, radiation

133
Q

Most benign brain tumor?

A

astrocytoma

134
Q

MC cause of meningitis in adults?

A

strep pneumoniae

135
Q

MC cause of meningitis in older children (10-19y)?

A

neisseria menigitidis

136
Q

MC cause of meningitis in newborns?

A

group B strep

137
Q

MC cause of meningitis in the immunocompromised?

A

Listeria monocytogenes

138
Q

What is Brudzinski sign?

A

neck flexion produces knee or hip flexion

139
Q

What is Kernig sign?

A

Inability to extend the knee/leg with hip flexion

140
Q

Dx of meningitis?

A

lumbar puncture

141
Q

What is seen on lumbar puncture in meningitits?

A

decrease glucose, increase neutrophils, increase protein, increase opening pressure

142
Q

Txt for bacterial meningitis?

A

Vancomycin + Ceftriaxone

143
Q

Txt for listeria meningitis?

A

Vancomycin + Ceftriaxone + Ampicillin

144
Q

What should be given w/ abx in bacterial meningitis?

A

Dexamethasone

145
Q

Post-exposure prophylaxis for bacterial meningitis?

A

Ciprofloxacin or Rifampin

146
Q

What is complex regional pain syndrome?

A

autonomic dysfunction following bone or soft tissue injuries

147
Q

Sx of complex regional pain syndrome?

A

pain, hypalgesia, allodynia, trophic changes,

148
Q

Txt for complex regional pain syndrome?

A

NSAIDS, anesthetic blocks

149
Q

What prophylaxis can be used after fractures to reduce complex regional pain syndrome?

A

Vitamin C

150
Q

MC area of berry aneruysm?

A

Circle of Willis (anterior communicating artery)

151
Q

Gold standard dx of berry aneurysm?

A

angiography

152
Q

Txt for aneurysm?

A

surgical clipping, endovascular coiling within first 24 hours

153
Q

Glasgow Coma scale of what is indicative of coma?

A

<9

154
Q

What 3 things should be checked in a non responsive patient after ABCs?

A

Glucose (for low blood glucose levels)
Thiamine (Wernicke)
Narcan (opiates)

155
Q

MC type of ischemic stroke?

A

Middle cerebral artery

156
Q

Location of stroke when symptoms are greater in the leg, foot, and can cause urinary incontinence?

A

anterior cerebral artery

157
Q

Location of stroke that causes vomiting, vertigo, visual changes?

A

Posterior cerebral artery

158
Q

Location of stroke that causes sx in the face, arm?

A

middle cerebral artery

159
Q

Txt for ischemic stroke?

A

alteplase (thrombolytic)

Internal Med PAEA (9 decks)

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