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1
Q

trihexyphenidyl (and benztropine)

A

anticholinergic drug for PD –decrease Sx PD. Interfere with DA neurotransmission by creating relative deficiency of ACh neurotransmission

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2
Q

haloperidol, pimozide, trifluoperazine, fluphenaine

A

Tourette syndrome - suppress tics

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3
Q

L-Dopa / Carbidopa –mech of action

A

L-Dopa – crosses BBB, dopa decarboxylase converts it to DA

Carbidopa –does not cross BBB, inhibits dopa decarboxylase and stops conversion

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4
Q

meige syndrome – & some drugs that bring it on & Tx

A

focal dystonia: blepharospam, jaw opening, lip retraction, neck contractions, tongue thrusting

  • -phenothiazine, butyrophenone
  • -Tx-botulinum
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5
Q

ET vs PD

A

ET does not have general slowing, mainly effects head and arms (unlike PD). ET occurs during action and stops when limb is relaxed

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6
Q

vegetative state

A

autonomic activity is sustained without cog fcn

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7
Q

locked-in syndrome

A

consciousness is preserved

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8
Q

Tardive Dyskinesia

A

involuntary movements of tongue, face, arms, etc.

use “tricks” to alleviate

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9
Q

PD tremor vs cerebellum tremor

A

PD = resting

Cerebellum tremor = intention

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10
Q

T1 vs T2 vs FLARE vs DWI

A

T1: bright = white matter
T2: bright = old infarct, CSF
DWI: bright = acute infarct
T1/FLARE: dark = CSF

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11
Q

OD phenytoin SFx

A

nystagmus (“lateral beating movements of the eyes”)

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12
Q

Rinne vs Weber

A

Weber: BC is equal always
Sensorineural loss - softer side
Rinne: BC > AC = louder side Sensorineural loss - softer side

Sensorineural loss = injury to R cells in cochlea or to the cochlear division of auditory nerve
Conductive loss = injury in the system of membranes and ossicles designed to focus the sound of the cochlea

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13
Q

CN V Damage
CN VII Damage - ear
CN VIII Damage

A

CN V = loose TM but no change
CN VII = stapedius muscle -hyperacusis (inc sensitivity to sound)
CN VIII = hearing loss

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14
Q

Stroke workup process

A

immediate: labs, CT non-con, ECG
secondary: brain, heart (TTE)

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15
Q

Vertigo locations

A

vestibular system, cerebellum

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16
Q

BPPV vs
Vestibular neuritis vs
Labyntheritis vs
Meniere Syndrome

A

BPPV - vertigo + nystagmus
Vestibular neuritis - vertigo wo hearing loss
Labyntheritis - vertigo + hearing loss
Meniere Dz - episodes of vertigo, tinnitus, hearing loss

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17
Q

epilepsy vs

deja vu

A

epilepsy - cerebral cortex

deja vu - temporal love

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18
Q

Primary generalized seizure etiologies

A

hereditary, toxic-metabolic insult

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19
Q

EEG Patterns
Absence vs
JME vs
MG

A

Absence = 3Hz generalized spike + wave
**Not Complex Partial S – no aura, no postictal
JME = 4-6 Hz irreg polyspike + wave
MG = 3-5 Hz with decremented response

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20
Q

JME Px

A

myoclonic jerks am
GTC or absence in a.m.
Fhx (auto-dom)
tx - lifelong AEDs/lamotrigene

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21
Q

MRI Gadolinium +

A

differentiate between neoplastic vs inflammatory

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22
Q

Causes of C6 Radiculopathy (5)

A 
herniated disk
osteophyte
tumor
hematomas
abscess
chronic meningitis
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23
Q

C6 Radiculopathy - no need to investigate

A

1 - Hx consistent with herniated disc
2 - Recent onset (go conservative mgmt.)
3 - sensory only (can have decrease reflexes)
\\
yes: motor sx/signs, chronicity, serious?

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24
Q

EMG vs NCS

A

EMG - muscles –> “denervation” shown by fibrillations/+sharp waves
NCS - myelin dmg / conduction slowed

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25
Q

Numbness in Hands and Feet - localization (4)

A

1 - Brain
2 - Brainstem fcn (CN deficits? vision loss?)
3 - Spinal Cord (bladder, bowel, sexual function)
4 - Nerves to muscle

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26
Q

Sensation - parasthesias and pain –where?

A 
nerve roots (ventral/anterior >>> dorsal/posterior)
\+ peripheral nerves
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27
Q

Reflex - how does it word? UMN/LMN

A

Spinal Reflex Arc – tendon->SC->contraction
LMN = SRA disruption (hypo)
UMN = central (hyper)

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28
Q

Coordination

A

cerebellar fcn

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29
Q

Axonal neuropathy vs

Demyelinating neuropathy

A

AN - toxic metabolic, vascular dmg

DN - acquired: GBS

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30
Q

GBS CSF findings

A 
Inc pr
nrm/inc WBC
**macrophage mediated demyelination (why pr inc)
-diffuse areflexia***
can get CN findings
peak 2-4 weeks, recovery wks-months
Cx: respiratory failure, dysautonomia
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31
Q

What decreases consciousness? (2)

A

1 -bi-cerebral hemispheres

2 - BS-RAS

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32
Q

Tonic Phase

A

urinary bladder incontinence, abdominal & respiratory muscle contraction, jaw clenching

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33
Q

Clonic Phase

A

rhythmic - violent shaking

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34
Q

Seizure / Generalized SE labs

A
  • serum chemistries + inf (hypomagnesium?)
  • PT/PTT and platelets
  • Drug toxicity & alcohol withdrawal
  • AED levels (too low?)
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35
Q

GSE Rx path

A

Ativan -> Ativan -> fosphenytoin -> phenobarbital (Must intubate 1st! bc respiratory depression levels)

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36
Q

Fosphenytoin - use and SFx

A

seizure prophylaxis

SFx - hypotension, cardiac arrhythmias

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37
Q

visuospatial impairment vs
difficulty with calculations vs
motor apraxia

A

visuospatial impairment - ex: can’t read clock face parietal lobes
difficulty with calculations - dom parietal lobes
motor apraxia - ex: dressing self - dom parietal lobe

38
Q 
Lobe localization:
frontal
temporal
parietal
occipitotemporal & occipitoparietal junction
A

frontal - paranoia, personality change, poor insight

temporal - memory

parietal - calculations, visuospatial, apraxia

occipitotemporal & occipitoparietal junction - complex visual hallucinations

39
Q

neurofibrillary tangles vs

senile (neuritic, amyloid) plaques

A

neurofibrillary tangles - hyperphosphorylated tau within neurons
senile (neuritic, amyloid) plaques - extracellular deposition of B-amyloid synaptic cleft = impairs transmission

40
Q

AD brain area progression

A

1 - hippocampus (medial temporal), postierior parieto-temporal cortex (word finding, calculations, spatial)
2 - Lateral temporal, frontal, and occipital levels (**social behavior preserved. poor judgement, delirium, agitation) -> akinetic mutism = cessation speaking

41
Q

AD mgmt. - Rx (2)

A

1 - Acetylcholinesterase inhibitors: donepezil, rivastigmine, galantamine–help attention, memory, learning
2 - NMDA antagonist: memantine –> blocks NMDA R (increase cognitive performance) … glutamate is neurotoxic

42
Q

meningitis 18-50

A

strep. pneumo
N. meningitides
H. flu

43
Q

meningitis: newborn

A

GBS, E. Coli, listeria

44
Q

meningitis: 3mo-18 yo

A

N. meningitides, S. pneumo, H. flu

45
Q

meningitis 50+

A

strep. pneumo
listeria
gram neg bacilli

46
Q

Nrm CSF

A 
Open P: 6-20mmHg
WBC: 0-5
RBC: 0
Pr: 18-58
Glucose: 2/3 serum glucose
47
Q

Tx meningitis / N. meningitides

A

1 - Dexamethasone
2 - Cefotaxime or Ceftriaxone
+Vancomycin
3 - if pt 50+ add ampicillin

48
Q

Aphasias

  • “trans trend”
  • Broca = nonfluent
  • anomia
A
  • “trans trend” = repetition intact
  • “nonfluent” = broca issue
  • anomia = word finding deficit, rare isolation **does not mean mixed transcortical.
49
Q

Basilar migraine

A
  • vision disturbance -> can go blind
  • can have psychosis
  • *terrible headache
  • can have: syncope, transient quadriplegia
50
Q

Transient trigeminal neuralgia - causes

A

MS, basilar artery aneurysms, acoustic schwannomas, posterior fossa compression

51
Q

trigeminal neuralgia vs atypical facial pain

A

TN - paroxysmal, lancinating pains, unilateral

AFP - constant and deep pain can be unilateral or bilateral

52
Q

Migraine Rx: abortive vs prophylaxis

A

Abortive: triptans, ergotamine, metoclopramide (nausea)
Prophylaxis: propranolol, verapamil, amitriptyline, valproate

53
Q

Cluster headaches vs vertebrobasilar headahces

A

cluster headaches - men can be irritable, look for seasonality
verebrobasilar headaches - look for initial vision issues, then headache, then can have: psychosis, hemiplegia, etc.

54
Q

intracranial HTN causes:

A

pseudo tumor cerebri, SLE, renal dz, hypoparathyroidism, radical neck dissection, vit A intoxication, steroid withdrawal

55
Q

Nerve involved in sarcoidosis

A

facial nerve

56
Q

Brain enhancing lesions in AIDs patients (2)

A
  • CNS lymphoma –> get LP, check CSF for EBV

- Toxoplasmosis

57
Q

Most common cause of acute encephalitis

A

herpes encephalitis - temporal, CSF with increased number of lymphoctyes

58
Q

common meningitis

A

neonate: GBS, E. Coli, listeria
6mo-6 yrs: strep pneumo, N meningitis, HiB, enterococcus
6yrs-60yrs: strep pneumo, N meningitis, enterococcus, HSV
60+yrs: S. pneumo, G-, listeria

59
Q

PML Etio

A
  • HIV/AIDs

- Oligodendrocytes with abnormally large nuclei with dark staining inclusions

60
Q

Most common adult brain tumor and type

A
  • GBM (astrocytoma)

- from glial cells

61
Q

Most common met to brain is from…

62
Q

Most common location for met in brain…

A

grey/white junction, where bloodborn cells will stop and grow (especially the cerebellum and cerebral hemispheres)

63
Q

Hypothalamic hamartomas vs
Malignant tumors
(cause and tx)

A

Hypothalamic hamartomas - increases function and overproduction of GHrH –> precocious puberty. Tx by Sxx!

Malignant tumors – Tx = CHEMO!!

64
Q

Paraneoplastic cerebellar degeneration - Sx, CA that causes (3 in order)

A

Sx - progressive ataxia, dysarthria, nystagmus

CA - small cell carcinoma of lung > ovarian carcinoma > lymphoma

65
Q

Hypercalcemia - neurologic Sx

A

fatigability, lethargy, generalized weakness, areflexia

66
Q

RLS - Tx and worseners

A

Tx - clonazepam, gabapentin, L-dopa, DA agonists (pramipexole, ropinirole), opiates

Worseners - neuroleptics, calcium channel blockers, caffeine

67
Q

Nicotinic Acid Deficiency

A

Pellagra - skin, CNS, digestive tract, hematopoietic system

68
Q

Vitamin E Deficiency

A

-Neuro Dz rare but is in childhood -spinocerebellar degeneration

69
Q

Pickwickiann Syndrome

A

Obesity + hypersomnia

70
Q

Females with Fragile X gene have 50% chance?

A

mental retardation

71
Q

divalproex sodium = ?

A

Depakote / valproate / valproic acid

72
Q

Correcting sodium too fast up or down = ?

A

Correcting serum Na+ too fast: ƒ “From low to high, your pons will die” (osmotic demyelination syndrome) ƒ

“From high to low, your brain will blow” (cerebral edema/herniation)

73
Q

Wilson disease (hepatolenticular degeneration)

A
  • Copper accumulates, especially in liver, brain, cornea, kidneys, joints.
  • Presents before age 40 with liver disease (eg, hepatitis, acute liver failure, cirrhosis), neurologic disease (eg, dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, Kayser-Fleischer rings (deposits in Descemet membrane of cornea) A, hemolytic anemia, renal disease (eg, Fanconi syndrome).
  • Treatment: chelation with penicillamine or trientine, oral zinc.
74
Q

Tuburous Sclerosis - Infantile spasms/seizures Tx

75
Q

Down Snydrome - brain deformity

A

smaller than normal for age and body size

76
Q

Fetal alcohol impacts what CNS part of fetus?

A

impaired neuronal migration

77
Q

Type 1 and 2 chiari malformations - when becomes Sx? What Sx?

A

T1 and 2 -mostly adult as ataxia

T2 - might be kids as hydrocephalus with retardation

78
Q

Pt with small cell carcinoma can get what kind of myopathy?

A

Dermatomyositis – as a part of a paraneoplastic syndrome

79
Q

Myotonic dystrophy - later Sx

A
  • balding
  • testicular atrophy
  • agitation
  • heart defects
  • cataract development
  • EMG with “dive bomber pattern”
80
Q

Myositis with CK - nrm? abn?

A

Nrm CK = PMR

Inc CK = dermatomyositis, polymyositis

81
Q

Papillitis vs ICP and Papiledema

A

Papillitis= vision loss (and pain with moving globe as well as light pressure)
*no vision loss with ICP and Papiledema

82
Q

Eye findings:

cHTN

A

AV nicking - segmental narrowing of the arteries (not drusen)

83
Q

Face injury - CN most likely injured

A

CN 4 - bc it goes most anterior to the orbit (also shares a nerve sheath with CN V1)

84
Q

Drug that causes NYSTAGMUS

A

Alcohol and Barbiturates

85
Q

Fredreich Ataxia - spinal involvement

A
  • lesion not in cerebellum, it is the spinocerebellar tracts

- peripheral neuropathy from DRG invovlement

86
Q

B12 def vs Thiamine def

A

B12 - Subacute Combined Degeneration -> dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

Thiamine - CAN: Confusion, Ataxia, Nystagmus

87
Q

ADEM (Acute Disseminated Encephalomyelitis) vs MS

A

-Look the same on MRI
ADEM = monophasic
vs
MS = polyphasic

88
Q

DM - ocular nerve palsy

A

CN 3 palsy

89
Q

Multiple foci of punctate hemorrhage = ?

A

Diffuse axonal injury

90
Q

LT improvement of pt with severe traumatic head injury

A

hypothermia! **NOT PROPHYLATIC HYPERVENTILATION

Neurology (5 decks)

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