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Eugenie Notes > Notes 5 > Flashcards

Notes 5 Flashcards

1
Q

Infective endocarditis tx?

A

Antibx, AP and AC is contraindicated as it can cause hemorrhage.

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2
Q

SAH from aneurysm ruptures are usually/not usually assoc with vasospasm

A

Not usually

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3
Q

Sickle cell: ICH or ischemic is more common

A

ischemic

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4
Q

In children with sickle cell + concern for stroke, whats special about management?

A

TCDs periodically, when inc velocities are detected, blood transfusions have been shown to reduce risk of stroke.

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5
Q

Antibody assoc with Miller Fischer variant of GBS?

A

Anti-GQ1b

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6
Q

DIC vs TTP
PLTS
schistocytes
D-dimer
fibrinogen
clotting time

A

DEC DEC
PRESENT PRESENT
ELEVATED NORMAL
REDUCED NORMAL
INCREASED NORMAL

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7
Q

uremic encephalopathy can cause myoclonus due to?

A

alterations in cerebral phosphate metabolism

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8
Q

Dialysis dysequilibrium syndrome

A

can range from mild encephalopathy to fatal cerebral edema.
Results from shifts of water into the brain due to changes in osmotic gradient.

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9
Q

Polyarteritis nodosa: Neuro manifestations

A

Seizures
mononeuritis multiplex
Cranial neuropathies
peripheral neuropathies

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10
Q

Churg Strauss Syndrome

A

Asthma, eosinophilia, sinua and pulmonary involvement

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11
Q

Wegener granulomatosis
What is it and how to dx

A

sinus, pulmonary involvement + glomeruonephritis
Dx: granulomas on biopsy, c-ANCA+ and proteinase-3 Ab +

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12
Q

Kawasaki Disease

A

fever, conjunctivitis, mucositis, rash, lymphadenopathy
- inc risk of coronary artery disease
- neuro manifestation of aspeptic meningitis

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13
Q

Pituitary blood supply?

A

Superior/Inferior hypophyseal arteries which arise from ICA

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14
Q

Diabetes insipidus (central)

A

deficiency of ADH (responds to ADH/desmopressin trial)

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15
Q

Diabetes insipidus (peripheral)

A

due to inadequate renal response to ADH
does not respond to desmopressin trial

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16
Q

Urine osmolality in diabetes insipidus

A

low (not absorbing any water so you are peeing it all out)

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17
Q

Cerebral salt wasting
what is it and tx

A

from excessive renal losses of sodium
seen in patients with CNS injuries
(pathology unclear, thought to be from inc atrial natriuretic peptide released from cardiac atria)

tx with salt supplementation or iso/hypertonic IV fluids

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18
Q

SIADH: tx?

A

fluid restrict and correct underlying cause (medication induced, head trauma, paraneoplastic ADH production_

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19
Q

postpartum cerebral angiopathy
what is it and tx

A

on the spectrum of RCVS due to multifocal vasospasms
p/w HA, seizures, focal deficits

Tx with CCBs +/- steroids

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20
Q

pre/eclampsia
what is it, sx and tx

A

HTN + proteinuria and often edema in the face/feet
Eclampsia = pre-eclampsia + seizures

Sx: headache, visual changes, seizures, PRES

Tx: delivery, IV mag, IV anti-hypertensives

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21
Q

Patient’s with antiphospholipid syndrome + acute onset chorea

A

chorea gravidarum

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22
Q

MOA of amphetamine

A

causes immediate release of dopamine and NE and inhibits their reuptake.

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23
Q

MOA of cocaine

A

inhibits reuptake or dopamine and NE (no direct release)

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24
Q

Both cocaine and amphetamine act on the reward centers:

A
  1. ventral segmental area
  2. nucleus accumbens

to produce a euphoria feeling

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25
Q

classic MRI finding in Wernicke’s encephalopathy

A

petechial hemorrhages in mamillary bodies, hypothalamus, medial thalami, periaqueductal grey matter

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26
Q

MOA of alcohol

A

stimulates GABA receptors (similar to benzos)

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27
Q

MOA of nicotine

A

nicotinic Ach receptor agonist inc release of dopamine)

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28
Q

MOA of caffeine

A

adenosine receptor inhibitor = less inhibition on excitatory NTs -> more cortical excitability

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29
Q

MOA of PCP/ketamine

A

glutamate NMDA receptor antagonist (can cause hallucinations, seizures)

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30
Q

excess zinc can lead to

A

a copper deficiency which presents as a myelopathy similar to SCD seen in B12 def.

sensorimotor peripheral neuropathy with axonal loss, spastic paresis and posterior column dysfunction

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31
Q

Vitamin E deficiency
Caused by
sx

A

caused by chronic diarrhea and subsequent malabsorption of fat soluble food

can resemble friedrich’s ataxia: ataxia, dysarthria, areflexia, large fiber sensory loss

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32
Q

B1 thiamine deficiency?

A

2 types

Dry beriberi: axonal sensory loss
Wet beriberi: cardiac involvement (CHF, arrhythmias, cardiomegaly), peripheral edema

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33
Q

Arsenic poisoning presents with

A

garlic odor on the breath, encephalopathy, seizures

34
Q

cyanide poisoning p/w

A

bitter almond odor, rapidly lethal

35
Q

mercury toxicity p/w

A

previously known as mad hatter’s disease as hatters used to work with mercury when making hats.

p/w cerebellar signs, tender gums, excessive salivation, psych changes

36
Q

lead intoxication p/w? path?

A

abdominal pain, constipation, wrist/ankle drop
basophillic stippling of RBCs

37
Q

manganese toxicity
seen in patients w/
sx?
MRI?

A

chronic liver disease, those receiving TPN, and weilding/steel industry
parkinsons sx, personality changes, hallucinations, psychosis

high T1 signal in globus pallidus

38
Q

methanol toxicity is assoc with what neuro finding?

A

optic nerve necrosis

39
Q

vincristine and cisplatin assoc with

A

peripheral neuropathy

40
Q

methotrexate is assoc with

A

leukoencephalopathy and aseptic meningitis

41
Q

cytarabine is assoc with

A

aseptic meningitis, cerebellar syndrome

42
Q

5-fluorouracial is assoc with

A

cerebellar syndrome

43
Q

bevacizumab is assoc with

A

hemorrhagic stroke and ICH

44
Q

Rituximab is assoc with

A

PML!!

45
Q

Wernicke’s is due to

A

thiamine def

46
Q

Wernicke encephalopathy tried

A

Confusion
ataxia
nystagmus/ophthalmoplegia

47
Q

Wernicke MRI finding

A

hemorrhagic mamillary bodies

48
Q

Garlic breath

A

arsenic

49
Q

almond odor

A

cyanide

50
Q

alopecia + painful neuropathy: what exposure causes this

A

thallium

51
Q

Cherry red skin from exposure?

A

CO, cyanide

52
Q

wirst/foot drop in a patient with encephalopathy

A

lead poisoning

53
Q

globus pallidus necrosis

A

CO

54
Q

putamen necrosis

A

methanol

55
Q

Which brain organs do not have a blood brain barrier?

A

area postrema, subfornical organ, organum vasculosum, neurohypophysis, median eminence, pineal gland, subcommisural organ

56
Q

Post-transplant acute limbic encephalitis is usually caused by

A

HHV6, requires antiviral tx

57
Q

best predictor of poor outcome after anoxic injury

A

absence of pupil/corneal reflex after 3 days

58
Q

innervation of the dura?

A

supratentorial dura innervated by CN V while infratentorial is innervated by CN 10, 9, first 3 cervical nerves.

59
Q

CPP formula

A

MAP-ICP

60
Q

transtentorial (uncal) herniation

A

herniation of the medial temporal lobe -> compresses CN3 = blown pupils and corticospinal tract = contralateral hemiplegia

61
Q

Central herniation

A

downward displacement of the brainstem -> traction on CN6 = lateral rectus palsy and if more severe can cause BL uncal herniation

62
Q

subfalcine herniation

A

parenchyma (usually cingulate gyrus) herniates under the falx cerebri = usually asx but can cause ACA infarcts

63
Q

Most common location of saccular aneurysms (berry)

A
  1. Acomm
  2. Pcomm
  3. MCA
64
Q

cerebral vasospasm 2/2 ruptured aneurysm can be treated by

A

triple H therapy
HTN
hypervolemia
hemodilution

65
Q

located in deep vessels, the usual cause of deep BP related ICH?

A

Charcot Bouchard aneurysms

66
Q

spinal cord blood supply?

A

throughout it is supplied by posterior (from vertbral/PICA) or anterior spinal arteries. however, the T spine is supplied by a branch of the Aorta, making the T spine the most sensitive to ischemia

67
Q

Artery of adamkiewicz

A

arteries coming from the aorta to supply lumbosacral spinal cord

68
Q

somatotropic organization of the internal capsule?

A

anterior-> face
posterior->legs

69
Q

corticospinal pathway?

A

cortex -> corona radiata ->internal capsule -> cerebral peduncle (basis pedunculi) -> pons (basis pontis) -> medullary pyramids (85% decussate and 15% do not)

70
Q

somatotropic organization of the lateral corticospinal tract

A

leg laterally and hand medially

71
Q

sympathetic vs parasympathetic pathway for pre and post ganglionic tracts

A

Symp: short pre and long post
Para: long pre and short post

72
Q

NT in preganglionic neurons in both para and symp?

A

Ach

73
Q

NT in post ganglionic neurons in both para and symp?

A

Para: Ach
Symp: NE

74
Q

Cuneate carries info from trunk at what levels?

A

Above T6

75
Q

VPL of the thalamus

A

body sensation

76
Q

VPM of the thalamus

A

face sensation

77
Q

lateral geniculate of the thalamus

A

relay for vision

78
Q

medial geniculate nucleus of the thalamus

A

relay for hearing

79
Q

ventral lateral nucleus of the thalamus

A

receives projections from cerebellum and BG

80
Q

List the episodic ataxia syndromes

A

Episodic Ataxias
1: facial twitching, KCN1A mutation, responds to CBZ
2: brainstem sx: CACNA1A4, responds to diamox
3: vertigo/tinnitus
4: ocular motion abnormalities

Eugenie Notes (10 decks)

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