Neurology (p373-388) Flashcards
1
Q
A sudden, nonconvulsive focal neurologic deficit
A
Stroke
2
Q
What is the most common source of emboli for a stroke?
A
carotid artheroma
3
Q
Small infarct in the deep white matter, strongly associated with HTN and atherosclerosis
A
lacunar infarct
4
Q
Pt is receptive and speaks fluently but words do not make sense. Dx? lesion?
A
Wenickie’s is “wordy”- temporal lobe lesion
5
Q
Carotid emboli affects opthalmic artery. Dx?
A
Amaurosis fugax
6
Q
Vertebrobasilar artery stroke affects brainstem. Dx?
A
Drop attach, vertigo, CN palsy and coma
7
Q
Middle cerebral artery stroke affects dominant/frontal/temporal lobe. Dx?
A
aphasia
8
Q
Middle cerebral artery stroke affects nondominant frontal or temporal. Dx?
A
Sensory neglect and apraxia
9
Q
Middle or anterior cerebral artery affects parietal lobe on opposite side. Dx?
A
Hemiplegia
10
Q
Middle or anterior cerebral artery stroke affects frontal lobe. Dx?
A
urinary incontinence and grasp reflex
11
Q
Middle or posterior cerebral artery affects temporal or occipital lobe
A
homonymous hemianopsia
12
Q
Expressive frontal lobe lesion where pt is unable to verbalize. Dx?
A
Broca’s aphasia
13
Q
How many days post-infarct does edema in brain occur?
A
2-4 days
14
Q
What is decorticate posturing indicate? What’s it look like?
A
cortical lesion, flexion of the arms
15
Q
What is decerebrate posturing indicate? what’s it look like?
A
Midbrain or lower lesion, arm extension
16
Q
What is the best Dx method for stroke? Gold standard?
A
Dx - CT but if negative, still need MRI head to rule out
17
Q
How quickly after onset can tPA be initiated?
A
after 3-6 hours of onset, only for occlusive disease, not hemorrhagic
18
Q
What is an absolute contraindication to tPA use?
A
intracranial bleed
19
Q
What fraction of patients achieve full recovery of lifestyle after a stroke?
A
less than 1/3
20
Q
What are the top 3 organisms that cause meningitis in adults
A
S. pneumo (50%)
N. meningitidis (25%)
H. influenzae (rare bc vaccine)
21
Q
What populations is listeria seen?
A
Neonates, pregnant women, elderly and immunocompromised pts
22
Q
What are the top 2 organisms that cause neonatal meningitis?
A
Group B strep (s. agalactiae)
E. Coli
23
Q
Sign when pt cannot touch chin to chest
A
Meningismus
24
Q
What is kernig’s sign?
A
pt is supine with hip and knees flexed at 90 degrees, examiner cannot extend knee
25
What is Brudzinski's sign?
Pt is supine, when examiner flexes neck, pt involuntarily flexes hips and knees
26
What could be the causes of subacute/chronic meningitis?
fungal, mycobacterial, syphillis, non infectious disease like lymphoma/leukemia spreading to CSF or rarely carcinomatosis, SLE vasculitis, sarcoid
27
What are some causes of fungal meningits?
Cryptococcus and Coccidioides
28
What is the CSF findings in bacterial meningitis?
___ Cells?
___ Protein
___ Glucose
___ Cells? increased neutrophils
___ Protein elevated
___ Glucose low
29
What is the CSF findings in viral meningitis?
___ Cells?
___ Protein
___ Glucose
___ Cells? lymphocytes
___ Protein elevated/nml
___ Glucose normal
30
What is the CSF findings in fungal meningitis?
___ Cells?
___ Protein
___ Glucose
___ Cells? lymphocytes
___ Protein VERY elevated
___ Glucose low
31
What is the emperic therapy for community acquired meningitis by age?
Neonates?
Children-65 yrs?
>65 yrs?
Neonates 65 = ceftriaxone +vancomycin + penicillin
32
What fungal organism is seen in AIDS pts and causes meningitis?
Cryptococcus
33
What is the treatment for cryptococcal meningitis?
IV amphotericin +/- flourocytosine followed by fluconazole
34
What kind of stain will show Cryptococcus in the CSF?
India ink
35
What kind of fungal meningitis is seen in Arizona/ California?
Coccidioides
36
What is the treatment for TB meningitis when seen in the elderly?
RIPE
| Rifampin, Isoniazid, Pyrazinamide and Ethambutol
37
What is the treatment for brain abscesses?
surgical drainage and antibiotics
38
What is the disease with unknown etiology, but causes relapsing limb weakness, increased deep tendon reflexes, nystagmus, tremor, sccanning speech, paresthesias, optic neuritis and +Babinski sign?
Multiple sclerosis
39
Where is MS common
Northern latitiudes
40
What is seen on lumbar puncture in patients with MS?
increased CSF immunoglobulines manifested as multiple oligoclonal bands on electrophoresis
41
What is the treatment for MS?
interferon B or glatiramer acetate --> may induce prolonged remission in some patients
42
Disease that's an acute autoimmune demyelinating dz involving peripheral nerves. Ascending weakness/paralysis, bilateral facial nerve palsy, may be preceded by gastroenteritis
Guillain-Barre Syndrome
43
What are some causes to Guillain Barre syndrome?
Campylobacter
Mycoplasma
viral infection
immunization
44
What is seen on CSF to Dx guillain barre?
albumin-cytologic dissociation (CSF protein very high, without increase in cells seen)
45
What is the treatment for Guillain barre?
Plasmapharesis, IVIG, intubation for respiratory failure
46
What kind of demyelination occurs in central pontine myelinolysis?
diamond shaped region of demyelination in the basis pontis
47
Pt with bilateral pallidal necrosis, headache, nausea, cherry red color of lips
Carbon monoxide poisoning
48
Lesion related to mammilary bodies
Thiamine deficiency which causes Wernickie's encephalopathy
49
Where is the degeneration neurologically for B12 deficiency?
posterior columns and lateral corticospinal tract
50
What labs do you do for B12 deficiency that are more sensitive than than B12?
Methylmalonic acid and homocysteine levels
51
What is another name of Hepatolenticular degeneration?
Wilson's disease
52
Where is the brain lesion in Wilson's disease?
basal ganglia
53
How do you diagnose Wilson's disease?
decreased serum ceruloplasmin
54
What is the treatment for Wilson's disease?
penicillamine or liver transplant if drug fails
55
Why does hepatic encephalopathy occur?
brain toxicity secondary to excess ammonia and other toxins not degraded by malfunctioning liver
56
What are some findings seen in hepatic encephalopathy?
hyperreflexia, asterixis, dementia, obtundation/coma
57
What is the treatment for hepatic encephalopathy?
lactulose, neomycin and protein restriction to decrease the ammonia related toxins
58
What is the protein defect in Tay Sachs disease? What does it lead to a build up of?
Hexosaminidase A defect leads to build up of ganglioside GM2
59
What is seen on the macula of a Tay Sach's pt?
Cherry red spot
60
How do you diagnose Tay Sachs?
biopsy of rectum or enzymatic assay, no Tx
61
What is a complex seizure?
Loss of consciousness
62
What is a simple seizure?
No loss of consciousness
63
What is a generalized seizure?
Entire brain involved
64
What is a partial seizure?
Focal area of brain involved
65
What is a tonic sz?
prolonged contraction
66
What is a clonic sz?
twiches
67
What kind of sz is an absence sz?
complex generalized sz = brief LOC
68
What kind of sz is a grand mal sz?
Complex generalized tonic-clonic sz
69
What is one blood test you must always do in a pt who has a hx of seizure?
check blood level of medication
70
What is a side effect of phenytoin?
gingival hyperplasia and hirsuitism
71
What is a side effect of carbamazepine?
leukopenia/aplastic anemia and hepatotoxicity
72
What is a side effect of Valproate?
Neutropenia, thrombocytopenia and hepatotoxicity
73
At what point can you stop sz treatment?
If no seizure for 2 years and normal EEG
74
Pt with breif period of unresponsiveness
Absence Seizure
1st line: ethosuximide/valproic acid
2nd line: lamotrigine
75
Pt with dramatic convuslsions, LOC, incontinence and post-ictal confusion.Dx? Tx 1st line?
Tonic Clonic seizure (grand mal)
| 1st line: Valproic acid, carbamazepine, phenytoin
76
Pt with sensory seizure or limited focal motor seizure. Dx? Tx?
Simple partial sz
| Tx: Carbamazepine, phenytoin
77
Pt with sz that starts as simple partial but then generalizes. Dx? Tx?
Complex partial sz
| Tx: carbamazepine, phenytoin
78
Pt with unremitting seizure --> respiratory compromise and rhabdomyolysis. Dx? Tx?
Status epilepticus
| Tx: lorazepam/diazepam
79
Continuous seizing lasting >5 minutes
status epilepticus
80
How do you treat status epilepticus?
Maintain and protect airway, IV benzodiazepines for immediate control, followed by phenytoin loading and phenobarbital for refractory cases
81
What age group does Alzheimer's dementia primarily affect? In Down's syndrome pts?
>70 yrs
| In Down's 30-40 years
82
Review Dementia vs Delirium table
p.386
83
What is the efficacy of cholinesterase inhibitors on dementia?
slow early dementia, but no efficacy in late disease
84
How is diagnosis of Alzheimer's done? Difinitively?
Clinical dx, definitive is only possible at autopsy
85
What is the only drug out there to treat moderate to severe Alzheimer's
Memantine - protects brain cells from damage caused by the chemical messenger glutamate, but efficacy is uncertain.
86
Pt presents with acute, stepwise decrease in neurologic function, multiple focal deficits on exam, HTN, old infarcts by CT or MRI. Dx?
Multiinfarct Dementia - make Dx by clinical and radiographic
87
Pt presents clinically similar to alzheimer's, more in women, onset at younder age . Predominates frontal (more personality changes seen) and temporal lobe
Pick's Dz
88
Pt presents with tremor, cog-wheel rigidity, bradykinesia, classic shuffling gait, mask-line facies +/- dementia
Parkinsonism
89
What kind of neurons degenerate in Parkinsonianism?
Dopaminergic neurons in the substantia nigra
90
What drug is the best for bradykinesia?
Levedopa-carbidopa (Sinemet)
91
What is the best drug for tremor?
Anticholinergic like Benztropine
92
What drug increases dopamine release and is good for mild Parkinson dz?
Amantadine
93
What surgical options are available for Parkinsons?
Implanted deep brain stimulation, surgical pallidotomy for refractory cases
94
Pt presents with progressive choreioform movements of all limbs, ataxic gait and grimacing. Dx?
Huntington's chorea
95
What is the gene defect in Huntington's?
Autosomal CAG triplet expansion
96
What part of the brain is atrophied in HD?
atrophy of striatum (especially caudate nucleus)
97
How is dx of HD made?
MRI - looking for atrophy of the caudate
98
Pt presents with upper and lower motor neuron disease causing weakness, fasciculations, progressing to denervation atrophy, hyperreflexia, spasticity and difficulty speaking/swallowing. Dx?
Amyotrophic Lateral Sclerosis (Lou Gehrig's Dz, motor neuron dz)
99
What are the 3 types of cerebral palsy
Spastic cerebral palsy
Athetoid or dyskinetic cerebral palsy
Ataxic cerebral palsy
100
What is the most common form of CP?
individual's' muscles are stiff, making movement difficult
101
What kind of CP can affect the entire body?
Athetoid/dyskinetic CP
102
How do you treat CP?
Botox or baclofen to decrease spasticity
103
What is the cause of CP?
70% of cases are events occurring before birth that impair normal brain development. In many cases, cause is unknown.
