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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
Numbness in Hands and Feet - localization (4)
1 - Brain 2 - Brainstem fcn (CN deficits? vision loss?) 3 - Spinal Cord (bladder, bowel, sexual function) 4 - Nerves to muscle
26
Sensation - parasthesias and pain --where?
``` nerve roots (ventral/anterior >>> dorsal/posterior) + peripheral nerves ```
27
Reflex - how does it word? UMN/LMN
Spinal Reflex Arc -- tendon->SC->contraction LMN = SRA disruption (hypo) UMN = central (hyper)
28
Coordination
cerebellar fcn
29
Axonal neuropathy vs | Demyelinating neuropathy
AN - toxic metabolic, vascular dmg | DN - acquired: GBS
30
GBS CSF findings
``` 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 ```
31
What decreases consciousness? (2)
1 -bi-cerebral hemispheres | 2 - BS-RAS
32
Tonic Phase
urinary bladder incontinence, abdominal & respiratory muscle contraction, jaw clenching
33
Clonic Phase
rhythmic - violent shaking
34
Seizure / Generalized SE labs
- serum chemistries + inf (hypomagnesium?) - PT/PTT and platelets - Drug toxicity & alcohol withdrawal - AED levels (too low?)
35
GSE Rx path
Ativan -> Ativan -> fosphenytoin -> phenobarbital (Must intubate 1st! bc respiratory depression levels)
36
Fosphenytoin - use and SFx
seizure prophylaxis | SFx - hypotension, cardiac arrhythmias
37
visuospatial impairment vs difficulty with calculations vs motor apraxia
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
``` Lobe localization: frontal temporal parietal occipitotemporal & occipitoparietal junction ```
frontal - paranoia, personality change, poor insight temporal - memory parietal - calculations, visuospatial, apraxia occipitotemporal & occipitoparietal junction - complex visual hallucinations
39
neurofibrillary tangles vs | senile (neuritic, amyloid) plaques
neurofibrillary tangles - hyperphosphorylated tau within neurons senile (neuritic, amyloid) plaques - extracellular deposition of B-amyloid synaptic cleft = impairs transmission
40
AD brain area progression
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
AD mgmt. - Rx (2)
1 - Acetylcholinesterase inhibitors: donepezil, rivastigmine, galantamine--help attention, memory, learning 2 - NMDA antagonist: memantine --> blocks NMDA R (increase cognitive performance) ... glutamate is neurotoxic
42
meningitis 18-50
strep. pneumo N. meningitides H. flu
43
meningitis: newborn
GBS, E. Coli, listeria
44
meningitis: 3mo-18 yo
N. meningitides, S. pneumo, H. flu
45
meningitis 50+
strep. pneumo listeria gram neg bacilli
46
Nrm CSF
``` Open P: 6-20mmHg WBC: 0-5 RBC: 0 Pr: 18-58 Glucose: 2/3 serum glucose ```
47
Tx meningitis / N. meningitides
1 - Dexamethasone 2 - Cefotaxime or Ceftriaxone +Vancomycin 3 - if pt 50+ add ampicillin
48
Aphasias - "trans trend" - Broca = nonfluent - anomia
- "trans trend" = repetition intact - "nonfluent" = broca issue - anomia = word finding deficit, rare isolation **does not mean mixed transcortical.
49
Basilar migraine
- vision disturbance -> can go blind - can have psychosis - *terrible headache - can have: syncope, transient quadriplegia
50
Transient trigeminal neuralgia - causes
MS, basilar artery aneurysms, acoustic schwannomas, posterior fossa compression
51
trigeminal neuralgia vs atypical facial pain
TN - paroxysmal, lancinating pains, *unilateral* AFP - constant and deep pain *can be unilateral or bilateral*
52
Migraine Rx: abortive vs prophylaxis
Abortive: triptans, ergotamine, metoclopramide (nausea) Prophylaxis: propranolol, verapamil, amitriptyline, valproate
53
Cluster headaches vs vertebrobasilar headahces
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
intracranial HTN causes:
pseudo tumor cerebri, SLE, renal dz, hypoparathyroidism, radical neck dissection, vit A intoxication, steroid withdrawal
55
Nerve involved in sarcoidosis
facial nerve
56
Brain enhancing lesions in AIDs patients (2)
- CNS lymphoma --> get LP, check CSF for EBV | - Toxoplasmosis
57
Most common cause of acute encephalitis
herpes encephalitis - temporal, CSF with increased number of lymphoctyes
58
common meningitis
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
PML Etio
- HIV/AIDs | - Oligodendrocytes with abnormally large nuclei with dark staining inclusions
60
Most common adult brain tumor and type
- GBM (astrocytoma) | - from glial cells
61
Most common met to brain is from...
lungs
62
Most common location for met in brain...
grey/white junction, where bloodborn cells will stop and grow (especially the cerebellum and cerebral hemispheres)
63
Hypothalamic hamartomas vs Malignant tumors (cause and tx)
Hypothalamic hamartomas - increases function and overproduction of GHrH --> precocious puberty. Tx by Sxx! Malignant tumors -- Tx = CHEMO!!
64
Paraneoplastic cerebellar degeneration - Sx, CA that causes (3 in order)
Sx - progressive ataxia, dysarthria, nystagmus | CA - small cell carcinoma of lung > ovarian carcinoma > lymphoma
65
Hypercalcemia - neurologic Sx
fatigability, lethargy, generalized weakness, areflexia
66
RLS - Tx and worseners
Tx - clonazepam, gabapentin, L-dopa, DA agonists (pramipexole, ropinirole), opiates Worseners - neuroleptics, calcium channel blockers, caffeine
67
Nicotinic Acid Deficiency
Pellagra - skin, CNS, digestive tract, hematopoietic system
68
Vitamin E Deficiency
-Neuro Dz rare but is in childhood -spinocerebellar degeneration
69
Pickwickiann Syndrome
Obesity + hypersomnia
70
Females with Fragile X gene have 50% chance?
mental retardation
71
divalproex sodium = ?
Depakote / valproate / valproic acid
72
Correcting sodium too fast up or down = ?
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
Wilson disease (hepatolenticular degeneration)
- 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
Tuburous Sclerosis - Infantile spasms/seizures Tx
ACTH
75
Down Snydrome - brain deformity
smaller than normal for age and body size
76
Fetal alcohol impacts what CNS part of fetus?
impaired neuronal migration
77
Type 1 and 2 chiari malformations - when becomes Sx? What Sx?
T1 and 2 -mostly adult as ataxia | T2 - might be kids as hydrocephalus with retardation
78
Pt with small cell carcinoma can get what kind of myopathy?
Dermatomyositis -- as a part of a paraneoplastic syndrome
79
Myotonic dystrophy - later Sx
- balding - testicular atrophy - agitation - heart defects - cataract development - EMG with "dive bomber pattern"
80
Myositis with CK - nrm? abn?
Nrm CK = PMR | Inc CK = dermatomyositis, polymyositis
81
Papillitis vs ICP and Papiledema
Papillitis= vision loss (and pain with moving globe as well as light pressure) *no vision loss with ICP and Papiledema
82
Eye findings: | cHTN
AV nicking - segmental narrowing of the arteries (not drusen)
83
Face injury - CN most likely injured
CN 4 - bc it goes most anterior to the orbit (also shares a nerve sheath with CN V1)
84
Drug that causes NYSTAGMUS
Alcohol and Barbiturates
85
Fredreich Ataxia - spinal involvement
- lesion not in cerebellum, it is the spinocerebellar tracts | - peripheral neuropathy from DRG invovlement
86
B12 def vs Thiamine def
B12 - Subacute Combined Degeneration -> dorsal columns, lateral corticospinal tracts, spinocerebellar tracts Thiamine - CAN: Confusion, Ataxia, Nystagmus
87
ADEM (Acute Disseminated Encephalomyelitis) vs MS
-Look the same on MRI ADEM = monophasic vs MS = polyphasic
88
DM - ocular nerve palsy
CN 3 palsy
89
Multiple foci of punctate hemorrhage = ?
Diffuse axonal injury
90
LT improvement of pt with severe traumatic head injury
hypothermia! **NOT PROPHYLATIC HYPERVENTILATION

Neurology (5 decks)

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