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Surgery > Neurology from PANCE Pearls > Flashcards

Neurology from PANCE Pearls Flashcards

1
Q

What is Parkinsonism

A

A disorder associated with tremor, bradykinesia, rigidity, and postural instability
It includes Parkinson’s Disease, Medications, Lewy Body Dementia and trauma

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2
Q

What is an essential tremor

A

Autosomal dominant inherited disorder of unknown etiology

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3
Q

Sx of Essential Tremor

A

Postural, bilateral action tremor of hands, forearms, head, neck or voice
Worsened with emotional stress and intentional movement
Tremor is shortly relieved with alcohol
No abnormal neurologic findings

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4
Q

Tx of Essential Tremor

A

None needed

Propranolol if severe

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5
Q

What is Parkinson’s Disease

A

Idiopathic dopamine depletion
Failure to inhibit acetylcholine in basal ganglia
See Lewy bodies and loss of pigment cells in substantia nigra

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6
Q

Sx of Parkinson’s Disease

A

Tremor: Resting tremor, pill rolling tremor
Bradykinesia: Slowness of voluntary movement and decrease of automatic movements, lack of swining of arms while walking/shuffling gait
Rigidity: Flexed posture
Instability: Postural instability
Face involvement: Imobibe face (fixed faces), widened palpebral fissures, seborrhea of skin, decreased blinking
Myerson’s Sign: Tapping the bridge of the nose repetitively causes a sustained blink

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7
Q

Tx of Parkinson’s Disease

A

Levodopa/Carbidopa (Levodopa is coverted to Dopamine)
Dopamine Agonists: Bromocriptine, Pramiprxole, Ropinirole (used in young patients to delay use of Levodopa/Carbidopa)
Anticholingergis: Block excitatory cholinergic effects (used in patients

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8
Q

What is Huntington’s Disease

A

Autosomal dominant neurodegenerative disease

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9
Q

Sx of Huntington’s

A

Sx usually start around 30yrs
Initially behavioral changes (personality, cognitive, intellectual, psych)
Chorea
Dementia

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10
Q

Dx of Huntington’s

A

CT shows cerebral and caudate nucleus atrophy

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11
Q

Tx of Huntington’s

A

No Cure

Control Chorea: Antidopamineric agents and Benzodiazepines

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12
Q

What is Guillain Barre Syndrome

A

Acute/Subacute inflammatory demyelination polyradiculopathy with symmetric Lower to Upper extremity WEAKNESS
ASCENDING WEAKNESS

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13
Q

What leads to Guillain-Barre Syndrome

A

Campylobacter or other antecedent respiratory or GI infeciton (CMV, EBV)
Demyleination and axonal degenation slows impulses which leads to symmetric weakness and parasthesias

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14
Q

Sx of Guillain Barre Syndrome

A

Symmetric weakness and parasthesias
Decreased DTR
Tachycardia, hypotension or HTN, breathing difficulties

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15
Q

Dx of Guillain Barre Syndrome

A

CSF: HIgh protein with normal WBC

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16
Q

Tx of Guillain Barre Syndrome

A

Plasmapheresis removes antibodies causing demyelination

IVIG suppresses harmful inflammation

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17
Q

What is Myasthenia Gravis

A

Autoimmune disorder of peripheral nerves

Common in young women

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18
Q

What causes Myasthenia Gravis

A

Autoimmune antibodies against acetylcholine post-synaptic receptor at neuromuscular junction leads to progressive weakness with repeated muscle use and recovery after periods of rest

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19
Q

Sx of Myasthenia Gravis

A

Ocular: Extraocular muscle weakness, Diplopia, Ptosis
Generalized muscle weakness, worse with repeated muscle use, relieved with rest, weakness with prolonged chewing, dysphagia

What makes this deadly is respiratory weakness leads to respiratory failure = Myasthenia Crisis

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20
Q

Dx of Myasthenia Gravis

A

Tensilon Test (Edrophonium): Rapid response to short acting IV edrophonium
Positive Ach-receptor Antibodies
Ice Pack Test

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21
Q

Tx of Myasthenia Gravis

A

Acetylcholinesterase Inhibitors: Pyridostigmine, Neostigmine
Immnosuppression with corticosteroids, Cyclosporine
Thymectomy if Thymoma present

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22
Q

What is Multiple Sclerosis

A

Autoimmune inflammatory demyelinating disease of CNS, axon degeneration of white matter of brain, optic nerves, and spinal cord

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23
Q

What are the different forms of Multiple Sclerosis

A

Relapsing-Remitting
Progressive
Secondary Progressive (relapse remitting pattern that becomes progressive)

24
Q

Sx of Multiple Sclerosis (3 major categories)

A

Optic Neuritis
Sensory Deficits
Spinal Cord Sx

25
Q

Sx of Multiple Sclerosis (detailed)

A

Optic Nueritis: Unilateral eye pain worse with eye movements, diplopia, scotoma/vision loss, blurry vision
Sensory deficits: Weakness, parasthesias, fatigue
Spinal Cord sx: Bladder, bowel or sexual dysfunction
Charcot’s Neurologic Triad: Nystagmus, Stacatto speech and Intentional tremor

26
Q

Tx of Multiple Sclerosis

A

Acute Exacerbations: Steroids

Relapse-Remitting/Progressive: Beta-Interferon, Amantadine for fatigue

27
Q

What is a Subarachnoid Hemorrhage

A

Arterial bleed between the arachnoid and pia

28
Q

What leads to a SAH

A

Berry Aneurysm rupture

AVM

29
Q

Sx of SAH

A

Thunderclap: Worse headache of my life, Unilateral, occipital
Meningeal sx: stiff neck, photophobia, delirium

30
Q

Dx of SAH

A

CT

If Negative do LP, look for RBC (Xanthochromia), increased CSF pressure, no focal neuro sx

31
Q

Tx of SAH

A

Supportive

Bed rest, stool softeners, anti-anxiety meds

32
Q

What is an Epidural Hematoma

A

Arterial beed between the skull and dura

33
Q

What causes an Epidural Hematoma

Which artery is most commonly affected

A

Skull fracture

Middle Meningeal Artery

34
Q

Sx of Epidural Hematoma

A

Brief LOC, Lucid Interval, Coma, Headache, N/V, Focal neuro sx, Rhinorrhea

35
Q

Dx of Epidural Hematoma

A

CT (Convex/sens shape, does NOT cross suture lines)

36
Q

Tx of Epidural Hematoma

A

Observation if small

37
Q

What is a Subdural Hematoma

A

Venous bleed between the dura and arachnoid due to tearing of BRIDGING veins

38
Q

What causes a Subdural Hematoma

A

Blunt trauma

Bleeding usually happens on side opposite of where trauma occurred

39
Q

Sx of Subdural Hematoma

A

May have neurologic sx

40
Q

Dx of Subdural Hematoma

A

CT (Concave/Crescent shape, can cross suture lines)

41
Q

Tx of Subdural Hematoma

A

Hematoma evacuation vs. supportive

If midline shift, must evacuate

42
Q

What is Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s Disease)

A

Necrosis of both upper and lower motor neurons

Progressive motor degeneration with normal sensory function

43
Q

Sx of ALS

A

Loss of ability to initiate and control motor movements with mixed UMN and LMN signs
Progressive bilateral fasciculations
Muscle Atrophy
Eventually, Respiratory dyxfunction

44
Q

Tx of ALS

A

Riluzole

45
Q

What is Delirium

A

An acute, abrupt confused state

Transient global disorder of attention

46
Q

What is Dementia

A

Progressive, Chronic Deterioration
Memory Loss and loss of impulse control, motor and cognitive functions that are not due to delirium, meds, or psych illnesses

47
Q

What is Alzheimer’s Disease

A

Loss of brain cells, amyloid deposition (senile plaques) in the brain, neurofibrillary tangles (tau protein)

48
Q

Tx of Alzheimer’s Disease

A 
Ach-esterase inhibitors (Donepezil, Rivatigmine, Galantamine)
NMDA Antagonists (Memantine)
49
Q

What is Pick’s Disease

A

Localized brain degeneration of the fonrtotemporal area which may progress globally
See marked personality changes

50
Q

What is Diffuse Lewy Body Disease

A

Abnormal protein deposits in nerve cells

51
Q

Sx of Diffuse Lew Body Disease

A

Visual Hallucinations, Delusions, Parkinsonism

52
Q

What is the most common artery affected by an Ischemic Stroke

A

Middle Cerebral Artery

53
Q

Sx with Middle Cerebral Artery Stroke

A

Contralateral sensory/motor loss/hemiparesis
Greater in face and arm
Gaza preference towards side of lesion

54
Q

Dx of Ischemic Stroke

A

Noncontrast CT to rule out hemorrhage

CT may be normal in first 6-24 hours

55
Q

Tx of Ischemic Stroke

A

Thrombolytic therapy within 3 hours of onset of cases of ischemic stroke (rTPA Alteplase
Antiplatelet therapy: ASA, Clopidogrel Dipyridamole

Surgery (12 decks)

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