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NMSP II Exam 1 > Random Neuro ClinMed (Hon) > Flashcards

Random Neuro ClinMed (Hon) Flashcards

1
Q

Who is Cryptococcal fungal meningitis most common in? (2)

A

immunocompromised or diabetic patients

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2
Q

What are the 3 first-line drugs used to treat bacterial meningitis?

A
  1. Vancomycin
  2. Ceftriaxone (3rd Gen cephalosporin)
  3. Steroids (Dexamethasone) –> prevent complications
  • do ASAP via IV –> do NOT delay treatment of patient
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3
Q

What are 5 common Infectious Encephalitis organisms commonly seen in adults?

A 
HSV 1 and 2
HIV
West Nile
Varicella Zoster
Treponema pallidum (Syphilis)

majority of pathogens causing encephalitis are viruses

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4
Q

Herpes Simplex 1 Encephalitis

Where is it located, what Abs are associated with it, and what is used to treat it?

A
  • focal abnormalities in TEMPORAL LOBE
    • headache, fever, impaired consciousness, seizures

Abs: NMDA autoantibodies –> secondary immune encephalitis

Tx: acyclovir

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5
Q

Autoimmune Encephalitis

What are they associated with, when does it commonly arise, and what are 4 treatment methods (I/P/R/C)?

A
  • associated with SEIZURE and intractable epilepsy
  • seen in pts. w/rapid (< 6wk) encephalopathy/psychiatric disturbances

Tx: IVIg, plasma exchange, RITUXIMAB, cyclophosphamide

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6
Q

NMDA Encephalitis

Who is it seen in, what are two labs that help diagnose it, and what presence is it associated with?

A
  • seen in young/middle-aged women

Labs: abnormal EEG with EXTREME DELTA BRUSH and NMDA receptor Abs (also pleocytosis/oligoclonal bands)

  • associated with the presence of a TERATOMA
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7
Q

LGI1 Encephalitis

Who is it seen in, how does it present, and what is required for treatment?

A
  • seen in men commonly

Sx: Faciobrachial Dystonic Seizures

  • same side face AND arm brief seizures
  • sleep disturbances, short-term memory issues

Tx: do NOT respond to antiepileptics; require IMMUNOTHERAPY
- 1/3 of pts RELAPSE

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8
Q

Which gender and from where is at inc. risk of MS?

What is seen on Lumbar Puncture?

A

Men > Women

Temperate Zones > Tropical Zone
- father from equator = inc. risk of MS

LP: oligoclonal bands and /or inc. IgG index/synthesis

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9
Q

What is seen on MS MRI?

A

MRI = ovoid lesions on T2W1 in periventricular WM and SC

- acute lesions get brighter with 2nd imaging

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10
Q

What 5 things are used in maintenance of MS (M/I/F/F/GA)

What is the only drug approved for Primary Progressive AND Relapsing/Remitting MS?

A
  • mAbs, interferons, fingolinmod, fumarates, Glatirimer Acetate
  • OCREVUS only drug for BOTH PP and RR MS
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11
Q

What two medications are used to treat ACUTE EXACCERBATIONS of MS?

A
  1. Methylprednisolone

2. ACTH (Acthar gel) or IVIg

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12
Q

Clinically Isolated Syndrome (CIS)

What is the difference between Monofocal and Multifocal?

What is another name for Multifocal Episode?

A

Monofocal: single neurological sign or symptom from a SINGLE lesion
- only happens ONCE

Multifocal: more than 1 neurological sign or symptom from lesions in MORE than 1 place
- only happens ONCE

Multifocal = Acute Disseminated Encephalomyelitis

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13
Q

Propranolol, primidone, clonazepam can be used to treat what in MS?

A

Intention Tremor

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14
Q

Devic’s Disease (Neuromyelitis Optica)

What is it, what are two labs that can help diagnose it, and how is it treated (R/S/PE)?

A
  • inflammation of demyelination of optic nerves/spinal cords
    • numbness/tingling/weakness/spasticity w/VISUAL issues

Labs: NMO (aquaphorin 4) and MOG Abs in blood/CSF

Tx: Rituximab, steroids, plasma exchange (ACUTELY)
- also azothiaprine/mycophenolate

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15
Q

What is Epilepsy?

A
  • 2 or more unprovoked seizures

Dx: made after 2 unprovoked seizures

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16
Q

Which epilepsy variant can be determined almost entirely on a SINGLE EEG?

A

Petit mal (w/HV) –> 90% positivity

% positive for ALL TYPES of epilepsy with 3 sleep-deprived EEFs = 85%

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17
Q

What is the single most important piece of information for diagnosis of epilepsy?

A

HISTORY of the events, preferably from an eye-witness

normal EEG does NOT exclude epilepsy presence

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18
Q

What is the difference between Myoclonic, Tonic, Clonic, and Atonic?

A

Myoclonic - brief jerks of extremities/trunk
Tonic - arms out front and extended
Clonic - jerking w/arms FLEXED
Atonic - go limp and fall down

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19
Q

What is the difference between these seizures:

  1. Simple Partial
  2. Complex Partial
  3. Secondary Generalized
A
  1. focal with no LOC; lasts seconds; NO post-ictal state
  2. nonresponsive staring w/possible aura preceding
    • 1-3 min; post-ictal state
  3. BILATERAL tonic-clonic activity; LOC; 1-3 min
    • post-ictal state
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20
Q

What is the difference between these Generalized seizures:

  1. Absence
  2. Tonic-Clonic
  3. Atonic
  4. Myoclonic
A
  1. nonresponsive staring, rapid blinks, chewing, LOC
    • 10-30 seconds, NO post-ictal state
  2. BILATERAL extension w/symmetrical extremity jerking
    • LOC; 1-3 min; post-ictal state
  3. sudden muscle tone loss, head drop, pt. collapse
    • LOC; post-ictal state
  4. brief, rapid symmetrical extremity/torso jerking
    • LOC; < few minutes; MINIMAL post-ictal state
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21
Q

What AED should NOT be given to pregnant women to treat seizures?

A

VALPROIC ACID

  • strongest Generalized seizure drug; VERY TERATOGENIC

synergistic with LAMOTRIGINE

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22
Q

What two AEDs are commonly used to treat seizures?

A

Leviteracetam and Lamotrigine

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23
Q

What is the only drug that is used for Absence Seizures?

A

Ethosuxamide

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24
Q

What is Status Epilepticus and what two drugs are commonly used to treat it?

If still seizuring after treatment with drugs, what should be done?

A

SE: prolonged seizure (> 10 min) or repeated seizures WITHOUT recovery in between

Tx: Benzodiazepine –> Leviteracetam (IV)

  • if unsuccessful –> midazolam/propofol IV (intubate pt before treatment)
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25
Q

What is a major consideration of treating women of child-bearing age for seizures?

A
  • should be on multivitamin with 1 mg. Folic Acid, as many of the AEDs are FOLATE-DEPLETING

Tx: drug that pt. responds the MOST to

26
Q

What is Transient Global Amnesia?

A
  • sudden, temporary, isolated episode of memory loss with NO OTHER neurologic symptoms/signs
  • patient knows self/family/close friends, but may not recognize others
  • last hours then resolves (asks some question multiple times till out of seizure)
27
Q

Why should Acute HTN in Ischemic Stroke NOT be treated?

A
  • area of infarction may have lost autoregulatory function, so that ‘normal’ BP may be relatively HYPOtensive in the brain
  • lowering BP may inc. risk of damage to area around CORE of stroke
28
Q

What do all stroke patients require and what should NOT be given to them?

A
  • all stroke patients require IV access and IV fluids should NOT contain GLUCOSE (hyperglycemia = WORSE outcome)
  • get two IV access sites if tPa is considered
29
Q

When should tPa be administered and is heparin useful for stroke patients?

A
  • tPa should be started within at least 3-4 1/2 hours in acute ischemic stroke patients
  • heparin is NOT useful for acute ischemic stroke patients
30
Q

What are two major scenarios where patients would need long-term anticoagulation therapy?

A

Atrial Fibrillation and Prosthetic Valves
- also MI, ASD, hypercoagulable state

  • use WARFARIN, Dabigatran, Riveroxaban, Apixaban
31
Q

What treatment of stroke has been shown to have improved outcomes compared to standard therapy?

A

Intra-arterial thrombolysis with clot reversal

32
Q

What is the major difference in presentation between these Akinetic Rigid Syndromes:

  1. Progressive Supranuclear Palsy
  2. Multiple System Atrophy
  3. Cortical Basal Degeneration
A
  1. loss of VOLUNTARY control of eye movements
    • especially vertical gaze
  2. PRONOUNCED autonomic dysfunction
    • EARLY vs Parkinsons Dz (late involvement)
  3. sensory loss, apraxia, myoclonus, aphasia
    • CORTICAL involvement

see Lewy Bodies, bradykinesia, rigidity

33
Q

Syndenham’s Chorea

Who is it seen in, what does it cause, and how can it be treated?

A
  • seen in children w/previous Group A Strep infection
  • causes UNILATERAL choreiform movements and behavioral changes

Tx: bedrest and antibodies

34
Q

What is the treatment Idiopathic Torsion Dystonia and Focal Torsion Dystonia?

A

ITD = low dose levodopa

FTD = Botulinum Toxin injections
- good use for Writer’s Cramp

35
Q

What is the definition of Gilles De La Tourette’s Syndrome?

A

Chronic multiple motor and vocal tics with onset before the age of 21 yo

36
Q

What is Essential Tremor?

A
  • postural or kinetic tremor of both hands; can involve head or voice
  • not seen till later in life
  • alcohol and decrease tremor temporarily
37
Q

What are the criteria for clinical diagnosis of Alzheimers Dz?

A
  • deficits in 2+ areas of cognition with worsening memory and NO disturbance in consciousness
    • onset around 40-90 yo (usually after 65 yo)
38
Q

What 2 categories of drugs are commonly used to slow Alzheimers Dz?

A
  1. Acetylcholinesterase Inhibitors - DONEPIZIL

2. NMDA Receptor Antagonist - MEMANTINE

39
Q

What is the Tetrad of (Diffuse) Lewy Body Dz?

A
  1. Dementia
  2. Parkinsonism (NO TREMOR)
  3. visual hallucinations/illusions (small animals/kids)
  4. EXTREME antipsychotic sensitivity

psychotic symptoms are much more common and occur earlier than Alzheimers Dz

40
Q

How should Lewy Body Dz be treated?

A
  • use newer antipsychotics, like quetiapine or olanzapine
41
Q

CADASIL’s Dz

What age range does it affect, what is it caused by, and how does it present?

A

age range: 40-50 yo

cause: hereditary stroke disorder from blood vessel smooth muscle degeneration
- MRI = multiple areas of ischemia

Sx: “migraine” headaches and TIAs/stroke
- seen years prior to symptom onset

42
Q

How do Visual, Labyrinthine, and Proprioceptive systems tell us about balance and body position?

A

Visual - distance
Labyrinthine - acceleration/position change
Proprioceptive - posture

43
Q

What does the Romberg Test tell us about?

A

PROPRIOCEPTION

44
Q

What is Benign Positional Vertigo?

A
  • idiopathic; spontaneous recovery occurs frequently
  • brief recurrent episodes of vertigo triggered by changes in HEAD POSITION
  • debris floating in endolymph of any of the semicircular canals (POSTERIOR is most common)
45
Q

What is the diagnosis of Benign Positional Vertigo confirmed by?

What can help treat this issue?

A

Dix-Hallpike position testing

  • usually resolves spontaneously but positional exercise is helpful
46
Q

What is Vestibular Neuronitis?

A
  • spontaneous vertigo w/NO hearing loss and is NOT positional; acute N/V
  • peaks at 24 hrs and lasts days –> weeks
  • resolves spontaneously; steroids can help
47
Q

What is Meniere’s Dz?

A
  • onset in 20-50 yo WOMEN due to inc. in volume of labyrinthine endolymph (POOR ABSORPTION)
  • recurrent spontaneous vertigo lasting > 20 min/< 24 hrs
  • LOW FREQUENCY hearing loss, tinnitus, aural fullness
48
Q

What are two useful treatments for Meniere’s Dz?

A
  1. Sodium Restriction

2. Diuretics: thiazides, furosemide

49
Q

What is Mal de Debarquement?

A

illusion of movement as an after effect of travel, like sea

  • rocking/swaying feeling almost immediately after cessation of event
50
Q

What are 5 common causes of Peripheral Drug Induced Disequilibrium? (A/Q/Abx/D/C)

A
  • alcohol, Quinine compounds, Antibiotics, diuretics, chemotherapeutics
51
Q

What is Friedrich’s Ataxia?

A
  • onset occurs before 20 yo with gait ataxia eventually of all 4 limbs; also muscle weakness and absent tendon reflexes
  • pts also have scoliosis, pes cavus, extensor plantar responses (UMN), and CARDIOMYOPATHY

NO TREATMENT AVAILABLE

52
Q

What is Ataxia-Telangiectasia?

A
  • progressive limb/trunk ataxia ( < 4 yo) with oculocutaneous telangiectasia, and recurrent sinopulmonary infection/pneumonia (immune def.)
    • nystagmus/dysarthria also present
  • telangiectasia appear in teen years; immune def. due to dec. IgA and IgE antibodies
53
Q

What two things does coma require?

A

only needs one of these two, if not both

  1. bilateral hemispheric dysfunction
  2. brainstem dysfunction (ARAS failure)
54
Q

What two things are required for consciousness?

A
  1. Arousal - alertness; interact with environment

2. Awareness - know what’s going on

55
Q

What are the 3 ‘P’s’ of pinpoint pupils?

A

Pontine lesion
oPiates
Pilocarpine

56
Q

By rule of thumb, what does an enlarged pupil on ONE side of a patients face usually indicate?

What is the difference between Conjugate and Dysconjugate Roving eye movements?

A

parasympathetic dysfunction due to CN VIII issues
- herniation can cause this

Conjugate = brainstem INTACT
Dysconjugate = brainstem LESION
57
Q

What eye movement is seen with Cold water irrigation to the ear with intact brainstem function?

A

Unilateral Ear –> eyes deviate to IRRIGATED side

Bilateral Ears –> eyes deviate DOWNWARD

58
Q

What is the difference between Decorticate and Decerebrate positioning of Coma patients?

A

Decorticate - arms flexed, legs extended
- HEMISPHERIC

Decerebrate - all extremities extended

  • BRAINSTEM
  • more ‘e’s’ = EXTENDED
59
Q

What herniation leads to ipsilateral dilated pupils (compressed CN VIII), ptosis, and eventually contral lateral brainstem compression causing ipsilateral hemiparesis?

A

Uncal Transtentorial Herniation

60
Q

What two things are associated with Cessation of Brain Function?

A
  1. Unresponsiveness - no response to ALL sensory input, including pain/speech
  2. Absent Brainstem Reflexes
    • use apnea test

only heartbeat remains

61
Q

What is the Apena Test?

A
  • used to help determine Brain Death (GOLD STANDARD)
  • pt. is given 100% oxygen; pts. pCO2 lvls are allowed to rise to 60 mmHg
    • if respiratory responses are absent at 8-10 min, they are brain dead

get ABG before AND after test

NMSP II Exam 1 (6 decks)

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