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Internal Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

[Diagnose]

68M chestpain with exertion, receotly passing out, history of DM with metformin

Midsystolic, cresendo-decresendo murmur at right 2nd ICS MCL

A

Dx: Cardiac syncope, due to aortic stenosis

Initial test: Echocardiography

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2
Q

If the syncope is unexplained and the patient has no heart disease, what is the most important test?

A

tilt-table testing

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3
Q

What is the most common cause of syncope?

A

neurally mediated (vasovagal)

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4
Q

What is the SBP cutoff that will result in syncope?

A

SBP 5mmHg or lower

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5
Q

What are the cutoffs to say that the patient has orthostatic hypotension?

A
  1. Reduction in SBP of at least 20 mmHg

2. DBP of at least 10 mmHg within 3 minute of standing or head-up tilt on a tilt table

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6
Q

What are the possible causes of sudden, no prodromal symptoms, cardiac syncope?

A
  1. Arrythmia
  2. Blood flow obstruction
  3. Massive MI
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7
Q

[Syncope vs seizures]

short duration myoclonic jerks <30s

A

syncope

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8
Q

[Syncope vs seizures]

preceded by aura/premonitory features; drowsiness/diorientation after attack

A

seizure

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9
Q

What is the hallmark of generalized seizures?

A

Tonic-clonic movements

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10
Q

What is the most common type of seizure?

A

generalized tonic-clonic

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11
Q

What is the most important diagnostic step in seizure?

A

EEG

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12
Q

[diagnose]

68M right sided weakness and language disturbance, known hypertensive for 10 years.

PE: 180/100, aphasic, gaze deviated to the left, motor strength RUE and LUE 0/5

A

Dx: Acute stroke, ischemic vs hemorrhagic

Next step: stabilize patient, rule out stroke mimickers

initial test: non-contrast CT of the head

Artery involved: left MCA

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13
Q

Cite examples of stroke mimickers

A
  1. Seizure
  2. Intracranial tumor
  3. Migraine
  4. metabolic ecephalopathy
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14
Q

TIA is diagnosed if ___

A

Presents as stroke symptoms but lasts <24 hours and resolve completely

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15
Q

[Non-contrast CT finding]

Dark areas on CT

A

Ischemic stroke

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16
Q

[Non-contrast CT finding]

white areas in the brain

A

hemorrhagic stroke

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17
Q

[Type of stroke]

deficit maximal at onset, very rapid

CT: dark areas

A

Ischemic

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18
Q

[Type of stoke]

Evolution of deficit over minutes ti hours

headache, vomiting, SBP >220

CT: white areas

A

hemorrhagic stoke

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19
Q

The most common site of hypertensive bleed

A

Basal ganglia (putamen, internal capsule)

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20
Q

Imaging study for stroke that is very sensitive but not preferred

A

MRI

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21
Q

[Types of intracranial bleeds]

Worst headache of my life

A

SAH

due to rupture of aneurysm

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22
Q

[Types of intracranial bleeds]

crescent shaped lesion

A

subdural

due to tearing of superior cerebral veins

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23
Q

[Types of intracranial bleeds]

biconcave disk-shpaed

A

Epidural

“lucid” interval, anterior division of middle meningeal artery

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24
Q

[Stroke localization]

weakness Left > Upper extremity

A

Anterior cerebral

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25
Q

[Stroke localization]

profound weakness of the upper extremity

Aphasia

A

middle cerebral

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26
Q

[Stroke localization]

vertigo, nausea, vomoting, dysarthria, ataxia, gait imbalance

A

vertebrobasilar artery

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27
Q

[Stroke localization]

amorausois fugaX

A

ophthalmic artery

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28
Q

[Stroke localization]

ipsilateral face, contralateral body, vertigo, horner syndrome

A

Posterior cerebellar

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29
Q

What is the most commonly affected artery in stroke?

A

MCA

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30
Q

How will you manage ischemic stroke?

A
  1. Thrombolytic therapy (rTPA)
  2. Aspirin, clopidogrel, cilostazol
  3. Anticoagulation for cardioembolic stroke
  4. Neuroprotection
  5. citicoline
  6. statin
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31
Q

How will you manage hemorrhagic stroke?

A
  1. BP reduction

2. Mannitor/HTS, elevate head 30-45 degreees, hyperventilate

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32
Q

What is the target pCO2 for patients suffering from hemorrhagic stroke?

A

pCO2 30-35

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33
Q

cut off time of administering thrombolytics

A

___ within 3 hours of the onset of symptoms

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34
Q

What are the 5H for neuroprotection

A

avoid:

  1. hypotension
  2. Hypoxemia
  3. Hypoglycemia
  4. Hyperglycemia
  5. Hyperthermia
35
Q

[diagnose]

60M, headache 10/10 worst headache of his life, nausea, vomiting for 2 hours

PE: sluggishly responsive pupil, right

A

Dx: SAH

initial test: Non-contrast CT of the head

Definitive test: Cerebral angiogram

Gold standard: lumbar puncture

36
Q

Third nerve palsy in subarachnoid hemorrhage is due to an expanding aneurysm at the ___

A

junction of the PCA and ICA

37
Q

What drug is used to control spasm in patients with SAH?

A

Nimodipine

38
Q

[Headache type]

unilateral/bilateral with aura

A

Dx: migraine

Abortive Tx: Sumatriptan
Prophylactic: Propranolol

39
Q

[Headache type]

unilateral, tearing and redness of eye, rhinorrhea, no aura

A

Dx: cluster

Abortive Tx: sumatriptan
Prophylactic Tx: verapamil

40
Q

[type of meningitis]

WBC >1000, mostly PMNs
Low glucose
High protein

41
Q

[Diagnosis]

headache, fever, stiff and painful neck

A

Dx: bacterial meningitis
Etiology: S. pneumoniae, N. meningitides, H. influenza

Initial test: CT scan of the head then CSF analysis

Accurate test: CSF culture

42
Q

[type of meningitis]

WBC < 300
Normal glucose
High protein

A

TB meningitis

43
Q

[type of meningitis]

WBC <300
Normal glucose
normal protein

A

Viral meningitis

44
Q

What is the most common cause of meningitis in neonates?

A
  1. GBS
  2. E. coli
  3. L. monocytogenes
45
Q

What is the most common cause of meningitis in children >3 months?

A
  1. N. meningitidis
  2. S. pneumoniae
  3. H. influenzae
46
Q

What is the most common cause of meningitis in adults?

A
  1. S. pneumoniae
  2. N. meningitidis
  3. H. influenzae
47
Q

What is the most common cause of meningitis in elderly?

A
  1. S. pneumoniae
  2. N. meningitidis
  3. L. monocytogenes
48
Q

What is the most common cause of meningitis in immunocompromised?

A
  1. L. monocytogenes
  2. Gram neg bacilli
  3. S. pneumoniae
49
Q

What is the best initial test for cryptococcal meningitis?

50
Q

What is the most accurate test for cryptococcal meningitis?

A

crytococcal antigen

51
Q

What is the best initial therapy for cryptococcal meningitis?

A
  1. Amphotericin B

2. 5 flucytosine

52
Q

[Dementia]

chronic progressive decline in multiple areas of cognitive functioning,
no focal deficit, >65 years old

A

Alzheimers

53
Q

[Dementia]

Parkinsonian symptoms + dementia

54
Q

[Dementia]

wet, weird, wobbly

A

normal pressure hydrocephalus

55
Q

What are the initial workup test will you request for patients with memory loss?

A
  1. head CT/MRI
  2. VDRL
  3. B12
  4. T4
56
Q

What is the CT scan finding in patients with alzheimer’s?

A

diffuse, symmpetric atrophy

57
Q

[diagnose]

resting tremors, festinating gait, hypominmia, intact cognition and memory

A

Parkinsons disease

58
Q

What is the drug of choice for a patient with parkinsons age 60 and above?

A

amantadine

59
Q

What is the first line drug for patients with severe parkinsons disease?

A
  1. Levidopa

2. Carbidopa

60
Q

What is the strongest risk factor for dementia?

A

increasing age

61
Q

[pharma]

Drug that inhibits DOPA carboxylase?

62
Q

[pharma]

peripheral COMT inhibitors

A

Entacapone

Tolcapone

63
Q

[pharma]

central COMT inhibitors

64
Q

[pharma]

MAO-B inhibitor

A

Resagiline

Selegiline

65
Q

[pharma]

Increases dopamine availability in the postsynaptic space

A

Amantadine

66
Q

[pharma]

dopamine agonist

A

Bromocriptine
Ropinirole
Pramipexole

67
Q

What is the most effective drug for parkinsons?

A

levodopa/carbidopa

68
Q

[parkinsons]

adjunct to levodopa and carbidopa

69
Q

[diagnosis]

demyelinating, previous diarrhea,
symmetric ascending muscle paralysis that begins in the lower extremity; rubbery legs

A

GBS

Tx: IVIg or plasmapharesis

70
Q

What are the commonly associated infections in GBS

A
  1. campylobacter jejuni

2. Herpesvirus

71
Q

What is the most specific diagnostic test for GBS>

A

nerve conduction study, electromyography

72
Q

What is the CSF finding in GBS?

A

markedly elevated protein concentration with normal cell count

73
Q

[diagnose]

diplopia, drooping eyelids, weakness of the muscles of mastication and dysarthria

associated with thymoma

snarling facial expression

A

Dx: Myasthenia Gravis

Pathophysio: antibodies against acetylcholine receptors

74
Q

What is the best initial test for MG?

A

Anti-acetypcholine receptor antibodies immunoassay

75
Q

What is the most accurate test for MG?

A

Clinical presentation and ACHR are more sensitive and specific than an edrophonium stimulation test

76
Q

What is the drug of choice for MG?

A
  1. Pyridostigmine

2. Neostigmine

77
Q

What is the clinical criteria for Schizophrenia according to DSM V?

A

At least 2 of the following at least 6 months

  1. Delusion
  2. Hallucination
  3. Disorganized speech
  4. Disorganized behaviour
  5. Negative symtoms
78
Q

What antipsychotic medications that diminish positive symtoms?

A
  1. First generation - chlorpromazine, Haloperidol

2. Second generation - clozapine, quetiapine

79
Q

[Diagnosis]

1 months of Delusion, Hallucination

80
Q

[Type of bipolar disorder]

Manic episodes + delusion, hallucinations

81
Q

[Type of bipolar disorder]

hypomanic + psychotic symptoms during depression

A

Bipolar II

82
Q

What are examples of manic episodes?

A
  1. Distractability
  2. Irresponsibility
  3. Grandiosity
  4. Flight of ideas
  5. Agitation
  6. Sleep, decreased need
  7. Talkativeness
83
Q

What are the criteria for MDD?

A

at least 5 of 9 for 2 weeks

  1. Sleep disturbance
  2. interest diminished
  3. Guilt
  4. Energy loss
  5. concentration decreased
  6. appetite change
  7. psychomotor retardation
  8. suicidal ideation

Internal Medicine (10 decks)

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