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Medicine > Neurology Part 2 > Flashcards

Neurology Part 2 Flashcards

1
Q

transient occurence of signs or symptoms due to abnormal excessive or synchronous neuronal activity

A

Seizure

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2
Q

2 or more unprovoked seizure

Risk of recurrent seizure due to chronic underlying process

Clinical phenomenon not disease

R/o trauma, infection, tumor, stroke, metabolic

A

Epilepsy

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3
Q

ILAE commission on classification and terminology

A

Clinical feature

EEG

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4
Q

Originate within networks limited to one brain region

Assoc with structural abnormalities of brain

Further described as intact or impaired awareness, motor or nonmotor, focal to bilateral tonic clonic

May evolve into generalized prev called focal with 2 generalization the new rely on type of gen seizure evolving from focal seizure

A

Focal

Partial no longer used.

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5
Q

Arise within and rapidly engage networks distributed across both cerebral hemisphere

Result from cellular, biochemical or structural abnormality with widespread distribution

Motor (tonic-clonic, atonic, myoclonic)
Nonmotor (absence)

A

Generalized seizure

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6
Q

New classification emphasizes on

A

Awareness (intact or impaired)

Nature of onset (motor or nonmotor)

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7
Q

Focal with intact awareness may be

A

Motor (tonic, clonic, myo)

Nonmotor (sensory, autonomic, emotional) without awareness impairment

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8
Q

Spread of activity over a progressively larger region of motor cortex

A

Jacksonian march - focal motor

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9
Q

Localized paresis for minutes to many hours in involved region following seizure

A

Todd’s paralysis - focal motor

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10
Q

Seizure continuing for hours or days

A

Epilepsia partialis continua - focal motor

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11
Q

Focal seizure manifestation

A

Somatic sensation (paresthesia)
Visual (flashing light or formed hallucination)
Equilibrium (sensation of falling or vertigo)
Autonomic dysfunction (flushing, sweating and piloerection)
Temporal or frontal (hearing, olfaction, emotional state)
Unusual intense odor (burning rubber, kerosene), sounds, epigastric from stomach or chest
Odd internal feeling, de ja vu, illusion of object appearing smaller (micropsia) or macropsia

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12
Q

Focal seizures with impaired awareness or unable to respond begin with

A

aura

Unable to respond to commands during seizure with impaired recollection of awareness of ictus

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13
Q

During start of ictal phase, the patient is in

A

motionless stare marking onset of impaired awareness

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14
Q

Focal seizures with impaired awareness also may come with

A

automatism (involuntary automatic behavior)
chewing
lip smacking
picking movement of hand

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15
Q

Sudden brief lapses of consciousness WITHOUT loss of postural control

Lasts for seconds

Consciousness returns as suddenly as it was lost

No postictal confusion

Main seizure type in 15-20% of children with epilepsy

A

Typical absence

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16
Q

Absence symptoms

A

Rapid blinking of eyelid
Chewing
Small amplitude clonic movement of hands

Childhood 4-10 years or early adolescence

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17
Q

First clue to absence is unexplained

A

daydreaming and decline in school performance

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18
Q

Absence electrophysiological hallmark

Provoked by

A

generalized, symmetric, 3 Hz spike and slow wave discharge beginning and ending suddenly superimposed on normal EEG background

Hyperventilation

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19
Q

Main seizure type in 10% of all persons with epilepsy

Most common type from metabolic derangement

Abrupt without warning

Initial tonic contraction

A

Generalized tonic-clonic seizure

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20
Q

Tonic contraction of muscle of expiration and larynx at onset will produce a loud moan

A

ictal cry

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21
Q

Impaired respiration
Secretions pool in oropharynx
Cyanosis

Contaction of jaw ms cause biting of tongue

Marked enhancement of sympathetic tone leading to inc in heart rate, blood pressure and pupillary size

A

Generalized tonic-clonic seizure

Tongue dep at bedside

Sidelie while lifting chin

It should stop in 2-3 mins

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22
Q

After 10-20sec

Superimposition of ms relaxation on tonic ms contraction

Lasts no more than 1 minute

Post ictal phase: unresponsiveness, muscular flaccidity, excessive salivation, bladder and bowel incontinence

A

Clonic phase

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23
Q

Sudden and brief ms contraction involving one or entire part of the body

Normal physiologic form of myoclonus is sudden jerking movement observed while falling asleep

A

Myoclonic seizure

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24
Q

Pathologic myoclonus seen in

EEG shows

A

Metabolic d/o
Degenerative CNS
Anoxic brain

Bilaterally synchronous spike and slow wave

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25
Q

Briefly sustained flexion or extension of proximal or truncal muscle

EEG shows

A

Epileptic spasm

Hypsarrhythmia - diffuse giant slow wave with chaotic background of irregular, multifocal spikes and sharp waves

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26
Q

Disorders in which epilepsy is predominant feature with evidence (clinical, EEG, Radio, genetic)

Suggesting common underlying mechanism

A

Epilepsy syndrome

Juvenile myoclonic epilepsy

Lennox Gastaut syndrome

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27
Q

Generalized seizure of unknown cause

Early adolescence

Bilateral myoclonic jerk may be single or repetitive

Myoclonic seizure most frequent in morning after awakening and provoked by sleep deprivation

A

Juvenile Myoclonic Epilepsy

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28
Q

Children

Triad:

Multiple seizures (GTC, atonic and absence)

EEG: <3Hz spike and wave discharge

Impaired cognitive function

A

Lennox Gastaut Syndrome

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29
Q

Loss of specific cell population within hippocampus
MRI: small hippocampus with inc T2 weighted sequence, small temporal lobe, enlarged temporal horn

Aura, behavioral arrest, automatism, unilat posturing, memory loss, dysphasia, post ictal disorientation

Hx of febrile seizure, family hx of epilepsy, early onset, rare gen seizure, remit and reappearing seizure, intractable

A

Mesial Temporal Lobe Epilepsy

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30
Q

Progressive myoclonus epilepsy gene mutation

Noncaspase cysteine protease inhibitor
Block neuronal apoptosis

A

Cystatin B

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31
Q

Progressive myoclonus epilepsy Lafora’s disease gene mutation

Protein tyrosine phosphatase PTP
anti-apoptotic activity

A

Laforin gene

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32
Q

Classic lissencephaly
MR
seizure

gene mutation

A

Doublecortin gene

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33
Q

Neonatal period and early infancy cause of seizure

A 
Hypoxic ischemic enceph
Trauma
CNS infection
Congenital CNS abnormality
Metabolic disorder 
Cocaine, heroin and ethanol taking mother
Hypoglycemia and hypocalcemia
Inborn errors of metab
Pyridoxine VitB6 deficiency
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34
Q

Most common cause of neonatal meningitis

A

Strep agalactiae
E coli
Listeria monocytogenes

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35
Q

Fetal alcohol syndrome

A

thin upper lip

smooth philtrum

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36
Q

Most common seizures arising in late infancy and early childhood

occur
peaks

A

febrile seizure

between 3 months - 5 years

peak at 18 to 24 months

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37
Q

GTC in febrile illness occurs because of

A

otitis media
respiratory infection
gastroenteritis

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38
Q

Most common cause of otitis media in children

A

Strep pneumoniae

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39
Q

Single isolated event, brief and symmetric

A

Febrile seizure

40
Q

Repeated seizure activity
>15 minutes
Focal feature

A

Complex febrile seizure

41
Q

Infants >1 mo <12 years

A

Febrile seizure
Genetic disorder
CNS infection

42
Q

Most common cause of seizure in adolescent 12-18

A

trauma

43
Q

Most common cause of seizure in adult 18-35

A

Trauma
Alcohol withdrawal
Autoantibodies NMDA

44
Q

Autoantibody directed against CNS antigen such as K ch or glutamate receptor

A

NMDA enceph

45
Q

Most common cause of seizure in older adults

A 
CVD
tumor
Alcohol withdrawal
Subdural hematoma 
Autoantibodies
46
Q

Drugs that cause seizure

A 
Alkylating (busulfan, chlorambucil)
Antimalarial 
Antimicrobial (b lactam)
Quinolone
Acyclovir
INH
Ganciclovir
Meperidine
Fentanyl
Tramadol
Ephedra
Gingko
Cyclosporine
Buproprion
Clozapine
Baclofen withdrawal
Amphetamine
Flumazenil
47
Q

Busulfan can cause

A

pulmonary fibrosis

also bleomycin

48
Q

Notorious b lactam for seizure

A

Imipenem

49
Q

Tramadol can cause

A

Seizure and hallucination

50
Q

Binds to SV2 receptor

Metabolized in kidney

A

Levetiracetam

51
Q

Inhibition of sodium dependent action potential

A 
Phenytoin
Carbamazepine
Lamo
Topimarate
Zonisamide
Lacosamide
Rufinamide
52
Q

Phenytoin causes

is a class I anti arrhythmic

A

gingival hyperplasia

53
Q

Topimarate can be used for

A

migraine

54
Q

Notorious for causing Steven Johnson Syndrome

A 
Phenytoin
Carbamazepine
Lamotrigine
Topimarate
Phenobarbital
55
Q

Ataxia

Nystagmus

A

Phenytoin toxicity

56
Q

Inhibits voltage gated calcium channels

A

Phenytoin
Gabapentin
Pregabalin

57
Q

Inhibits both Na And voltage gated Ca channels

A

Phenytoin

58
Q

Act on calcium channels (gabanoids) by binding to

A

alpha2 delta subunit

59
Q

Facilitates opening of K channels

A

Ezogabine

60
Q

Attenuates glutamate activity

A

Lamotrigine also Na inh
Topimarate also Na inh
Felbamate

61
Q

Potentiates GABA A receptor

A

Benzodiazepine

Barbiturates

62
Q

Increases availability of GABA

A

Valproic acid
Gabapentin
Tiagabine

63
Q

Modulates release of synaptic V2 receptors

A

Levetiracetam

Brivaracetam

64
Q

Inhibiting T type Ca channel in thalamic neurons for absence

A

ethosuxamide

valproic acid

65
Q

Drop attacks

Loss of postural tone

A

atonic seizure

66
Q

Drug of choice for infantile spasm

A

ACTH

67
Q

Kepra Levetiracetam is eliminated via

A

renal

68
Q

Rhythmic oscillation of body part due to intermittent muscle contraction

A

Tremor

69
Q

Involuntary, patterned, sustained, repeated ms contraction

twisting movement and abnormal posture

A

Dystonia

70
Q

Slow, distal, writhing involuntary movement with propensity to affect arms and hands dystonia of inc mobility

A

Athetosis

71
Q

Rapid semi purposeful graceful dancelike nonpatterned involuntary movement

A

Chorea

72
Q

Hypokinetic disorders

A

Bradykinesia (slowness)
Hypokinesia (dec amplitude)
Akinesia (absence of movement)

73
Q

Progressive neurodegenerative disorder

Movement disorder causing significant disability and dec quality of life

A

Paralysis agitans

PD

74
Q

Genes in Parkinsons

Protein in PD

A

PINK1
PARKIN gene

alpha synuclein

75
Q

Assoc with juvenile onset PD

A

pink1

76
Q

Main neuropathologic feature in PD

Eosinophilic round cytoplasmic inclusion

A

Lewy body

77
Q

PD features

A

Hypokinesia
Rigidity
Resting tremor
Postural instability

Other motor
Craniofacial
Hypomimia (masked facie, dec eye blinking)

Speech: hypophonia, hypokin dysarthria, dysphagia, sialorrhea

Ms: dystonia, stooped posture, camptocormia (severe kyphosis)

Gait: shuffling short step gait, freezing and festination

78
Q

Pull patient back and patient prevents self from falling but fails due to loss of balance

A

Retropulsion

79
Q

Inc synthesis of dopamine

A

L Dopa

80
Q

Inhibits breakdown of dopamine

A

Selegiline

81
Q

Stimulates release of dopa

A

Amphetamine

82
Q

Stimulates dopamine receptor sites directly

Also prolactinoma

A

Bromocriptine

Pramipexole

83
Q

Blocks uptake and enhances release of dopamine

Also in influenza

A

Amantadine

84
Q

Contraindications for rTPA

A

Recent surgery
BP >180
75-80 y/o
Neurologic deficit no more than 5 hrs onset

85
Q

Antiplatelet of choice for acute ischemic stroke

IST antithrombotic drug of study

A

Aspirin

86
Q

Cause of delayed neuro deficit in SAH

A

Vasospasm
Hydroceph
Rerupture

87
Q

First and most affected CN in ICP

A

CN VI
CN IV
CN III

88
Q

Abnormal gait
Dementia
Urinary incontinence

A

Normal pressure hydrocephalus

89
Q

Not characteristic of PD

A

Masked facies with inc blinking

90
Q

Brainstem, limbic, cortex

Fall with executive and personality changes

A

Progressive Supranuclear Palsy

Steele-Richardson Olszweki Syndrome

91
Q 
Dementia 
Movement do due to severe atrophy in perirolandic cortex and basal ganglia
Asymmetric rigidity
Dystonia
Myoclonus and apraxia of one limb
Alien limb
A

Corticobasal syndrome

92
Q

Amount of acetylcholine released per impulse declines on repeated activity

A

Presynaptic rundown

93
Q

Most common cause of acute gen weakness leading to ICU admission

A

GBS AND MG

94
Q

Parkinson plus syndrome with marked DYSAUTONOMIA

A

Shy Drager Syndrome

95
Q

Tremor
Bradykinesia
Cervical oromandibular
With DYT-3 mutation

A

X linked Dystonia-Parkinsonism

96
Q

Drugs avoided in MG

A

Gentamycin
Ciprofloxacin
Succinylcholine

Except insulin

97
Q

Neuropathologic feature of PD

A

Lewy body

Medicine (29 decks)

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