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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
Tx that extends the duration of Levodopa/Carbidopa?
Tolcapone, Entacapone (COMT inhibitors) | -- block metabolism of DA
26
Rasagiline - MOA?
MAO inhibitor -- blocks metabolism of DA - use w/ Levodopa/Carbidopa or as a single agent
27
Selegiline - MOA?
MAO inhibitor -- blocks metabolism of DA - use w/ Levodopa/Carbidopa or as a single agent
28
Non-pharma Parkinson's Tx that is highly effective for tremors & rigidity in some patients?
Deep Brain Stimulation
29
Which medication is capable of slowing the progression of Parkinson's?
MAO inhibitors are the only ones that can actually slow progression of the disease (b/c they prevent breakdown of DA)
30
When might you use Clozapine in Parkinson's?
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
w/ what meds do you have to avoid Tyramine-containing foods (i.e. cheese)?
MAO inhibitors
32
Dx? | Parkinsonism + Dementia?
Lewy Body Disease
33
What is Lewy Body Disease?
Parkinsonism + Dementia
34
What is Shy Drager Syndrome?
Parkinsonism predominantly w/ Orthostasis
35
Dx? | Parkinsonism predominantly w/ Orthostasis
Shy Drager Syndrome
36
Baclofen MOA?
GABA receptor agonist | muscle relaxant -- use for spasticity
37
Dantrolene MOA?
Prevents Ca2+ release from SR of skeletal muscle | muscle relaxant -- used for spasticity & neuroleptic malignant syndrome
38
Restless Leg Syndrome - Tx?
Dopamine agonists | Pramipexole
39
Spasticity (often ass'd w/ MS) - Tx?
- Baclofen - Dantrolene - Tizanadine (centrally-acting alpha-agonist)
40
Huntington genetic defect?
CAG trinucleotide repeats on Chromosome 4
41
Huntington Disease -- Dyskinesia is treated w/ what?
Tetrabenazine
42
Huntington Disease -- Psychosis is treated w/ what?
Haloperidol, Quetiapine, or a triad of different antipsychotics
43
What does head CT or MRI show in Huntington Disease?
Caudate Nucleus involvement
44
Tourette Disorder Tx?
Fluphenazine, Clonazepam, Pimozide, or other neuroleptic meds
45
Most common presentation of MS?
Focal sensory symptoms, w/ gait & balance problems | blurry vision or visual disturbance from optic neuritis no longer most common pres
46
What is Internuclear Opthalmoplegia (INO)?
Inability to adduct one eye w/ nystagmus in the other eye | characteristic of MS
47
MS - best initial test?
MRI
48
MS - most accurate test?
MRI
49
Which MS medication is ass'd w/ development of Progressive Multifocal Leukoencephalopathy?
Natalizumab | inhibitor of alpha-4 integrin
50
ALS presentation
Upper & motor neuron lesions | NO sensory loss
51
ALS -- which medication reduces glutamate buildup in neurons & may prevent progression of disease?
Riluzole
52
Riluzole - MOA?
Reduces glutamate buildup in neurons & may prevent progression of disease in ALS
53
ALS - Tx?
- 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
Charcot-Marie-Tooth Disease
Genetic disorder: - Distal weakness & sensory loss - Wasting in legs - Decreased DTRs - Tremor - Foot deformity w/ high arch common **NO Tx exists
55
Peripheral Neuropathy - causes?
- Diabetes Mellitus (most common) - Uremia - Alcoholism - Paraproteinemias like MGUS
56
Peripheral Neuropathy - Tx?
Pregabalin or Gabapentin are best initial Tx - TCAs & most seizure meds are helpful in some ppl
57
How to distinguish Stroke vs. Bell's Palsy?
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
Bell's Palsy symptoms?
- 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
Guillain Barre -- CSF analysis?
Increased protein w/ a normal cell count
60
GBS -- Tx?
IVIG or Plasmapheresis | but do NOT combine them
61
Myasthenia Gravis PE?
"Double vision & difficulty chewing" PE = Ptosis, weakness w/ sustained activity, & NORMAL pupillary responses
62
Myasthenia Gravis -- best initial test?
ACh receptor antibodies (80%-90% sensitive) - if neg, get anti-MUSK (muscle-specific kinase) antibodies
63
Edrophonium - MOA?
Short-acting acetylcholinesterase-inhibitor - temporarily bumps up ACh levels, improving motor fx as dx test in Myasthenia Gravis
64
Myasthenia Gravis - most accurate test?
Electromyography shows decreased strength w/ repetitive stimulation
65
What imaging should be done in Myasthenia Gravis & why?
Chest x-ray, CT, or MRI - to look for Thymoma or Thymic hyperplasia - CT w/ contrast is best
66
Myasthenia Gravis -- best initial Tx?
Neostigmine or Pyridostigmine | - longer acting versions of edrophonium
67
If initial Tx fails in Myasthenia Gravis, what next?
if < 60 yrs = Thymectomy if > 60 yrs = Prednisone, then Azathioprine, Cyclophosphamide, or Mycophenolate before serious steroid effects occur
68
Acute Myasthenia Gravis management?
IVIG or Plasmapheresis
69
Azathioprine -- MOA?
Antimetabolite precursor of 6-mercaptopurine that interferes w/ metabolism & synthesis of nucleic acids (AKA purine analog) - Toxic to proliferating lymphocytes - used in Leukemia
70
Azathioprine - Adverse effects?
- Bone marrow suppression | - Toxic effects inc'd by Allopurinol b/c its active metabolite mercaptopurine is metabolized by xanthine oxidase
71
4 Nitrosurea drugs
Carmustine, Lomustine, Semustine, Streptozocin
72
Nitrosureas: clinical use?
Brain tumors | including Glioblastoma Multiforme
73
Nitrosureas: MOA?
DNA Alkylation (x-links DNA strands) - require bioactivation - cross BBB into CNS
74
Nitrosureas: AEs?
CNS toxicity | dizziness, ataxia

3rd year_Neurology (8 decks)

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