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3rd year_Neurology > Neurology_MTB 2 > Flashcards

Neurology_MTB 2 Flashcards

1
Q

SAH Tx?

A

No Tx can reverse hemorrhage

  1. Nimodipine - prevents subsequent ischemic stroke
  2. Embolization - prevent repeated hemorrhage
  3. VP shunt - if ass’d w/ hydrocephalus
  4. Phenytoin - Seizure proph (controversial)
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2
Q

Dx?

- Loss of all fx except position & vibratory sensation below a specific spinal level

A

ASA infarction (Posterior Column intact)

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3
Q

How does ASA infarction present?

A
  • Loss of all fx except Post Column
  • Flaccid paralysis below level of infarction
  • Loss of DTRs & level of infarction
  • Evolves into spastic paraplegia several wks later
  • Loss of pain & temp
  • Extensor plantar response
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4
Q

Subacute Combined Degeneration of the Cord: causes?

A

B12 deficiency or Neurosyphilis

Pres: Position & vibratory sensation are lost

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5
Q

Spinal Trauma Tx?

A

Glucocorticoids

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6
Q

Syringomyelia: most accurate test?

A

MRI

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7
Q

Syringomyelia: best treatment?

A

Surgical removal of tumor if present & drainage of fluid from the cavity

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8
Q

Brain abscess can spread from where/what?

A
  • Can spread from a contiguous infection in the sinuses, mastoid air cells, or otitis media
  • Anything that leads to bacteremia (Pneumonia, Endocarditis)
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9
Q

Brain abscess presentation?

A

Headache, nausea, vomiting, fever, seizures, focal neurological deficit
(same as brain tumor)

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10
Q

Brain abscess: best initial test?

A

head CT or MRI

still must always biopsy to diff. from tumor

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11
Q

Brain abscess: most accurate test?

A

Biopsy

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12
Q

Duration of ABX Tx in brain abscess?

A

6-8 weeks IV, followed by 2-3 more months orally

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13
Q

Brain abscess: empiric Tx?

A

Penicillin (or Vanco) + Metronidazole + Ceftriaxone (or Cefepime)

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14
Q

Essential Tremor: best therapy?

A

Propranolol

classic pres: tremor improves w/ drink of alcohol

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15
Q

Parkinsonism: definition?

A

Loss of cells in Substantia Nigra resulting in a dec in dopamine
- results in mvmt disorder p/w tremor, gait disturbances, & rigidity

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16
Q

Parkinsonism causes?

A
  • Idiopathic (most common)
  • Repeated head trauma
  • Antipsychotic meds (Thorazine)
  • Encephalitis
  • Reserpine
  • Metoclopromide
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17
Q

Parkinson mild disease:

Tx?

A
  • Benztropine or Trihexyphenidyl (anti-ACh) – relieve tremor & rigidity
  • Amantadine – inc’s DA release from SN
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18
Q

Benztropine - MOA?

A

Anticholinergic medication used in Parkinson’s to relieve tremor & rigidity

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19
Q

Benztropine - AEs that occur more frequently in the elderly?

A
  • Dry mouth
  • Worsening prostate hypertrophy
  • Constipation
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20
Q

Trihexyphenidyl - AEs that occur more frequently in the elderly?

A
  • Dry mouth
  • Worsening prostate hypertrophy
  • Constipation
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21
Q

What to use in mild Parkinsons in elderly who are intolerant of anticholinergics?

A

Amantadine (inc’s DA release from SN)

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22
Q

Amantadine - MOA?

A

Increases DA release from the Substantia Nigra

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23
Q

Best initial Tx in severe Parkinsonism (pt unable to eat or care for themselves)?

A

Pramipexole & Ropinirole
– non-ergot DA agonists
(these are better than Bromocriptine, an ergot DA agonist)

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24
Q

Most effective Tx in severe Parkinsonism (pt unable to eat or care for themselves)?

A

Levodopa/Carbidopa

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25
Q

Tx that extends the duration of Levodopa/Carbidopa?

A

Tolcapone, Entacapone (COMT inhibitors)

– block metabolism of DA

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26
Q

Rasagiline - MOA?

A

MAO inhibitor – blocks metabolism of DA

  • use w/ Levodopa/Carbidopa or as a single agent
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27
Q

Selegiline - MOA?

A

MAO inhibitor – blocks metabolism of DA

  • use w/ Levodopa/Carbidopa or as a single agent
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28
Q

Non-pharma Parkinson’s Tx that is highly effective for tremors & rigidity in some patients?

A

Deep Brain Stimulation

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29
Q

Which medication is capable of slowing the progression of Parkinson’s?

A

MAO inhibitors are the only ones that can actually slow progression of the disease (b/c they prevent breakdown of DA)

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30
Q

When might you use Clozapine in Parkinson’s?

A

If they start having Psychosis & confusion symptoms
(b/c you cannot take them off anti-Parkinson meds even if these are the cause)
- Clozapine good b/c it’s a neuroleptic w/ few extrapyramidal (anti-dopaminergic) effects

31
Q

w/ what meds do you have to avoid Tyramine-containing foods (i.e. cheese)?

A

MAO inhibitors

32
Q

Dx?

Parkinsonism + Dementia?

A

Lewy Body Disease

33
Q

What is Lewy Body Disease?

A

Parkinsonism + Dementia

34
Q

What is Shy Drager Syndrome?

A

Parkinsonism predominantly w/ Orthostasis

35
Q

Dx?

Parkinsonism predominantly w/ Orthostasis

A

Shy Drager Syndrome

36
Q

Baclofen MOA?

A

GABA receptor agonist

muscle relaxant – use for spasticity

37
Q

Dantrolene MOA?

A

Prevents Ca2+ release from SR of skeletal muscle

muscle relaxant – used for spasticity & neuroleptic malignant syndrome

38
Q

Restless Leg Syndrome - Tx?

A

Dopamine agonists

Pramipexole

39
Q

Spasticity (often ass’d w/ MS) - Tx?

A
  • Baclofen
  • Dantrolene
  • Tizanadine (centrally-acting alpha-agonist)
40
Q

Huntington genetic defect?

A

CAG trinucleotide repeats on Chromosome 4

41
Q

Huntington Disease – Dyskinesia is treated w/ what?

A

Tetrabenazine

42
Q

Huntington Disease – Psychosis is treated w/ what?

A

Haloperidol, Quetiapine, or a triad of different antipsychotics

43
Q

What does head CT or MRI show in Huntington Disease?

A

Caudate Nucleus involvement

44
Q

Tourette Disorder Tx?

A

Fluphenazine, Clonazepam, Pimozide, or other neuroleptic meds

45
Q

Most common presentation of MS?

A

Focal sensory symptoms, w/ gait & balance problems

blurry vision or visual disturbance from optic neuritis no longer most common pres

46
Q

What is Internuclear Opthalmoplegia (INO)?

A

Inability to adduct one eye w/ nystagmus in the other eye

characteristic of MS

47
Q

MS - best initial test?

A

MRI

48
Q

MS - most accurate test?

A

MRI

49
Q

Which MS medication is ass’d w/ development of Progressive Multifocal Leukoencephalopathy?

A

Natalizumab

inhibitor of alpha-4 integrin

50
Q

ALS presentation

A

Upper & motor neuron lesions

NO sensory loss

51
Q

ALS – which medication reduces glutamate buildup in neurons & may prevent progression of disease?

A

Riluzole

52
Q

Riluzole - MOA?

A

Reduces glutamate buildup in neurons & may prevent progression of disease in ALS

53
Q

ALS - Tx?

A
  • Riluzole - reduces glutamate buildup in neurons & may prevent progression of disease
  • Baclofen treats spasticity
  • CPAP & BiPAP help w/ resp difficulties 2/2 muscle weakness
  • Tracheostomy & maintenance on ventilator often necessary when disease advances
54
Q

Charcot-Marie-Tooth Disease

A

Genetic disorder:

  • Distal weakness & sensory loss
  • Wasting in legs
  • Decreased DTRs
  • Tremor
  • Foot deformity w/ high arch common

**NO Tx exists

55
Q

Peripheral Neuropathy - causes?

A
  • Diabetes Mellitus (most common)
  • Uremia
  • Alcoholism
  • Paraproteinemias like MGUS
56
Q

Peripheral Neuropathy - Tx?

A

Pregabalin or Gabapentin are best initial Tx

  • TCAs & most seizure meds are helpful in some ppl
57
Q

How to distinguish Stroke vs. Bell’s Palsy?

A

Stroke - patient can wrinkle forehead on affected side (lower 2/3 face paralysis)

Bell - patient cannot wrinkle forehead on affected side (total face paralysis)

58
Q

Bell’s Palsy symptoms?

A
  • Paralysis of entire half of the face
  • Hyperacusis - Sounds are extra loud b/c Stapedius acts as “shock absorber” of middle ear
  • Taste disturbances in ant. 2/3 of tongue
59
Q

Guillain Barre – CSF analysis?

A

Increased protein w/ a normal cell count

60
Q

GBS – Tx?

A

IVIG or Plasmapheresis

but do NOT combine them

61
Q

Myasthenia Gravis PE?

A

“Double vision & difficulty chewing”

PE = Ptosis, weakness w/ sustained activity, & NORMAL pupillary responses

62
Q

Myasthenia Gravis – best initial test?

A

ACh receptor antibodies (80%-90% sensitive)

  • if neg, get anti-MUSK (muscle-specific kinase) antibodies
63
Q

Edrophonium - MOA?

A

Short-acting acetylcholinesterase-inhibitor

  • temporarily bumps up ACh levels, improving motor fx as dx test in Myasthenia Gravis
64
Q

Myasthenia Gravis - most accurate test?

A

Electromyography shows decreased strength w/ repetitive stimulation

65
Q

What imaging should be done in Myasthenia Gravis & why?

A

Chest x-ray, CT, or MRI

  • to look for Thymoma or Thymic hyperplasia
  • CT w/ contrast is best
66
Q

Myasthenia Gravis – best initial Tx?

A

Neostigmine or Pyridostigmine

- longer acting versions of edrophonium

67
Q

If initial Tx fails in Myasthenia Gravis, what next?

A

if < 60 yrs = Thymectomy

if > 60 yrs = Prednisone, then Azathioprine, Cyclophosphamide, or Mycophenolate before serious steroid effects occur

68
Q

Acute Myasthenia Gravis management?

A

IVIG or Plasmapheresis

69
Q

Azathioprine – MOA?

A

Antimetabolite precursor of 6-mercaptopurine that interferes w/ metabolism & synthesis of nucleic acids (AKA purine analog)

  • Toxic to proliferating lymphocytes
  • used in Leukemia
70
Q

Azathioprine - Adverse effects?

A
  • Bone marrow suppression

- Toxic effects inc’d by Allopurinol b/c its active metabolite mercaptopurine is metabolized by xanthine oxidase

71
Q

4 Nitrosurea drugs

A

Carmustine, Lomustine, Semustine, Streptozocin

72
Q

Nitrosureas: clinical use?

A

Brain tumors

including Glioblastoma Multiforme

73
Q

Nitrosureas: MOA?

A

DNA Alkylation (x-links DNA strands)

  • require bioactivation
  • cross BBB into CNS
74
Q

Nitrosureas: AEs?

A

CNS toxicity

dizziness, ataxia

3rd year_Neurology (8 decks)

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