Review Flashcards
1
Q
Stocking glove pattern of sensory origin suggests what?
A
Peripheral nerve disease - PNS
2
Q
What are some diagnosis that tells you if the CNS is involved?
A
Migraines
TIA/CVA
Demyelinating lesions
Infections
3
Q
What are some diagnosis that tells you if the PNS is involved?
A
Diabetic neuropathies
Guillain-Barre Strohl Syndrome
Poly/Mono Neuropathies
Amyotrophic Lateral Sclerosis
4
Q
Focal back pain with urinary incontinence suggests what?
A
Spinal cord origin - CNS
5
Q
What is postictal?
A
Recovery period following seizure activity
6
Q
What does graphesthesia test?
A
Ability to identify numbers written on the palms
7
Q
What does stereognosis test?
A
Ability to identify objects in the hand
8
Q
What is a CVA?
A
Sudden death of brain tissue due to lack of oxygen and blood flow to the brain.
- Ischemic 10x > hemorrhagic
9
Q
What is a TIA?
A
“mini stroke” similar sxs to a CVA but usually lasting only a few minutes to <24 hrs.
- w/o infarct
- causing no permanent damage.
10
Q
What are the SNOOP4 red flags?
A
- Systemic disease or symptoms
- Neurologic signs or symptoms
- Onset that is sudden
- Older than 40 years of age
- Progressive worsening
- Postural
- Precipitated by Valsalva maneuver or exertion
- Previous headache history with new feature
11
Q
Pt comes in with a “thunder-clap” HA, states pain worsens when laying down, what imaging would you do to diagnose the pt?
A
CT w/o contrast
12
Q
What is first line tx for cluster HA?
A
100% Oxygen
13
Q
Idiopathic intracranial hemorrhage is MC’ly seen in who?
A
Obese women of childbearing age
14
Q
What is the MC HA?
A
Tension HA
15
Q
Pt comes in with ear pain, jaw claudication, and has hx of polymyalgia rheumatica what do you suspect pt has and how would you diagnose?
A
- Temporal arteritis
- Get ESR done (would be elevated)
- Start high dose steroids
- Biopsy to confirm
16
Q
Pt who is a “frequent flyer” comes into the ER with a HA but states this HA is different that usual, what test would you perform?
A
CT scan then LP
17
Q
What is it called when pt has purposeless, involuntary, repetitive movements such as lip smacking, chewing, picking at clothings, may become aggressive if restraining is attempted?
A
Automatisms
seen in complex partial seizures
18
Q
What type of syncope is caused by fear of their blood being drawn?
A
Vasovagal syncope
19
Q
What type of syncope is caused when a pt is wearing a tshirt that is tight around their neck and when they move their neck or head it causes them to pass out?
A
Carotid sinus hypersensitivity
20
Q
What is the MCC for a pt to experience multiple epilepsy episodes?
A
Poor anticonvulsant medication compliance
21
Q
What is delirium?
A
An acute period of cognitive dysfunction due to medial disturbances or condition
22
Q
What is dementia?
A
A progressive deterioration of intellectual function.
23
Q
What are some general characteristics of lewy body dementia?
A
- Parkinsonian syndrome
- Visual hallucinations
- Fluctuations in attention and alertness
- Rapid eye movement
24
Q
What are some general characteristics of vascular dementia?
A
- Multi-infarct
- Diffuse white matter
- multiple small areas of ischemic damage
25
What are some general characteristics of alzheimers?
- Quantity of senile plaques
- Nerofibrillary tangles
- Progress at steady state
26
What would you see on a CT or MRI in a pt with alzheimers?
- Diffuse cortical atrophy
| - Enlargement of the ventricles
27
What are the 4 characteristics of narcolepsy?
- Sleep attacks
- Cataplexy (laughing then fall asleep)
- Sleep paralysis
- Hypnagogic hallucinations.
28
Obstruction of air flow in sleep apnea is typically located where?
Oropharynx
29
What would you use if pt declines CPAP or BiPAP?
Oral appliance (displaces the tongue and soft airway tissue)
30
What is the difference between snoring vs OSA?
- Snoring: partial obstruction of the airway
| - OSA: complete obstruction of the airway
31
What is a Tonic-Clonic (Grand Mal) Seizure?
- Bilaterally symmetric and without focal onset
| - Begins with sudden loss of consciousness
32
What is a Absence Seizure (petit mal seizures)?
Patients "stares off into space" and then returns to normal activity after a few seconds
33
What is Status Epilepticus?
Continuous seizure activity > 5-10 minutes or >2 seizures without full recovery
- always check finger stick blood glucose
34
What is a Generalized Seizure?
- Characterized by loss of consciousness
| - Involves disruption of the electrical activity in the entire brain
35
What is a Complex Partial Seizure?
- Consciousness is impaired
| - Accompanied by posticidal confusion
36
What is a Simple Partial/Focus Seizures?
Consciousness remains intact
37
A young girl comes into the ER d/t a seizure, she LOC, came back and LOC again. What would you diagnose her with and how would you treat?
- Status Epilepticus
| - IV Lorazepam
38
What is the syndrome called when a pt experiences abnormal involuntary stereotypes movements of the face mouth (lip smacking) tongue, trunk, and limbs. And what is it usually caused by?
Tardive Dyskinesia
| - caused by antipsychotic agents.
39
What type of tremor occurs in a pt with PD?
Resting tremor
40
Fine toning of the direct and indirect pathway is modulated by what?
Dopamine
41
What part of the brain is not degenerated in pts with HD?
Basal Ganglia
42
What tremor occurs when there are movements or when the body is activated and not at rest?
Essentail Tremor
43
A 73 yr old male pt comes into your office after returning from a trip to Mexico, you notice he has a mask like face, head is tilted forward, and has a pill rolling tremor, what do you suspect the pt has?
PD
44
Pt presents with a complaint of sudden brief involuntary movements what would you need in order to diagnose the pt?
Pts hx and family history
45
What are the 4 components to dx PD?
T: tremor (pill rolling)
R: rigidity (lead pipe)
A: akinesia/bradykinesia
P: postural
46
What are the progressive movement disorders?
HD
PD
Essential tremor
47
Pt comes in complaining of neuropathy, distal parenthesis, muscle weakness, reports sxs started after a recent respiratory infection. What do you suspect pt has?
Guillain Barre Syndrome
48
Pt with a recent hx of a right shoulder replacement after a car accident complains of severe pain in hand and allodynia what do you suspect pt has?
Complex regional pain syndrome
49
DM neuropathy most often affects which nerve?
```
CN III (oculomotor)
- eye pain, diplopia, ptosis, inability to adduct, pupils are spared.
```
50
What does thiamine deficiency (vitamin B1) cause?
- Wernicke encephalopathy (hallucinations, nystagmus, ataxia)
- Dry/ wet beriberi (neuro/cardio)
- GI (n/v)
51
What does cyanocobalamin deficiency (vitamin B12) cause?
- pernicious anemia
- hand numbness
- unsteady gait
- sensory/proprioception deficients
- diffuse hyperreflexia
- absent achilles reflex
- behavioral changes
52
What labs are elevated in cyanocobalamin deficiency (vitamin B12)?
Homocysteine and methylmalonic acid
53
What does the phalens sign elicit?
Tingling elicited when wrist are flexed for 30-60 seconds
54
What does the tinels sign elicit?
Tingling elicited when tapping over wrist with hammer or finer
55
What nerve causes carpal tunnel syndrome?
Median nerve
56
What nerve causes cubital tunnel syndrome?
Ulnar nerve
57
What nerve causes wrist drop?
Radial nerve
58
What nerve causes foot drop?
Peroneal nerve
59
Pt comes in c/o symmetrical central neuropathy, spasticity, and a positive Babinski, what vitamin deficiency would you suspect they have?
Vitamin B12
60
Pt with h/o alcoholism comes in c/o cold hands, difficulty holding things, forgetting appointment and has low labs, what vitamin deficiency would you suspect they have?
Vitamin B12
61
What is the role of Astrocytes?
- support and anchor neurons
- form the BBB
- maintain homeostasis
- most abundant, versatile, and highly branched glial cells
62
What are arteriovenous malformations (AVMs)
Snarled tangles of blood vessels that cause multiple irregular connections between the arteries and veins.
63
What are cavernous hemangiomas?
Group of tightly packed, abnormally thin-walled, small blood vessels. can cause seizures
64
What imaging would you do on a pt with a suspected CVA?
CT w/o contrast
65
What is an ischemic stroke?
A vessel supplying blood to the brain is obstructed
66
What is a hemorrhagic stroke?
Blood vessel within the brain parenchyma ruptures and causes accumulation of blood within the brain tissue.
67
What are risk factors for an ischemic stroke?
- HTN
- DM
- A. fib
- Smoking
- HLD
- Carotid stenosis
68
What are risk factors for an hemorrhagic stroke?
- HTN
- Amyloid angiopathy
- Anticoagulation use
- Thrombolytic use
- Neoplasm
- Trauma
69
Which is more common ischemic stroke or hemorrhagic stroke?
Ischemic
70
What is the MC neuro malignancy?
Astrocytoma
| - slow growing, can be anywhere in the brain
71
What are venous angiomas?
- Congenital malformation of radically arranged configuration of medullary veins (circular pattern) separated by normal brain parenchyma
- Usually benign and an incidental finding
72
Pt isb brought into the ER d/t being in a bike accident, he had LOC, came back, started to vomit, then had LOC again what do you suspect the pt has?
Epidural hemorrhage
73
What CN is affected in bells palsy that is not affected in in a CVA?
CN VII
74
What is the tx plan for bells palsy?
- Antiviral
- Corticosteroids
- Analgesia
- Ocular care: lubricants and patch at night
- Education/reassurance
- Return to clinic
75
What is the typical presentation of a brain abscess?
- HA
- Seizure
- Focal neuro deficits from increased ICP
- Confusion
76
What is responsible for CJD disease?
Prion
77
What structures make up the meninges?
D: dura matter
A: arachnoid matter
P: pia matter
78
Compare meningitis vs encephalitis
- M: bacterial infection of the brain and spinal cord
| - E: virus causing inflammation of the brain itself
79
What are the hallmark s/sx of meningitis?
- HA
- Fever
- Stiff Neck
- Changes in mental status
80
PA student comes into the ER with HA, fever, confusion, petechiae rash, increase protein, increased WBC, decreased glucose on LP what bug do you suspect is causing meningitis?
Neisseria meningitidis
81
16 yr old football player comes in to see you and reports brief LOC 2 wks ago at his game, but is now having trouble concentrating, what do you dx him with?
Post-concussion syndrome
82
What do you dx a 1st grader who seems to "stare off into space"?
Absence seizure
83
Dad brings in 15 mo toddler in to see you, he reports pts older sister took away his toy, the pt turned turned blue and passed out, what do you do?
Complete well child exam and do vaccines
84
Permanent brain injury is at its highest when associated with what?
2nd impact syndrome
85
LP finding for bacterial meningitis?
- Turbid
- Protein: > 1 (high)
- Glucose: < 50 (low)
86
LP finding for viral meningitis?
- Clear
- protein: < 1 (low)
- Glucose: normal
87
What is the pattern of inheritance of Duchenne muscle dystrophy?
- X-linked recessive
- Mom is carrier
- Son will have it and daughter will be a carrier
88
In utero hypoxia can cause what?
Microcephaly
89
An 8 yr old presents with an intense HA, states it last 2 hrs. The 1st line tx is rest and sleep in dark room, what would be the second line?
NSAIDs
90
What is the MC seizures in peds?
Febrile seizures
91
A 24 hr old infant is hypotonic, apgar score of 9, mom had myasthenia gravis during pregnancy, what do you tx with?
Pyridostigmine- acetylcholinesterase inhibitor
92
What is clinically useful to blocking pain when suturing?
Lidocaine
93
What is the MOA of phenytoin?
Na+ channel blocker
94
Pt presents with 20 min of generalized shaking tonic- clinic 1st line medication does not work so you try 2nd line, what is the drug and why do you need to be cautious when using this drug?
Phenytoin
| - Vascular and dermatological rxns
95
What is the MOA of benzos?
Positive allosteric effector of GABA-A
96
What is the main PK feature of carbamazepine that can be problematic?
Induces its own metabolism
97
What would you do if a pt presents with a rash after taking lamotrigine?
Strop taking immediately
98
Pt takes clonazepam daily for seizures, after 2 mos of that dose it is increased to get same effect, what is that called?
Tolerance
99
PK properties of enzyme inducers can case contraceptive failure due to what?
Enzyme reduction
100
Pts current loading dose of Phenytoin is 300mg reports it is not working, what do you do?
Increase to 400mg
101
A 62 yr old bipolar disorder, recently switched to valproic acid, tolerating well, and mood is stable, pt wants to take aspirin every day to get healthy, however she started noticing increased drowsiness and dizziness. why is that?
Aspirin displacing valproic acid from protein
102
A 7 yr old brought in for staring off into space you diagnose him with an absence seizure, how do you treat?
Ethosuximide
103
A 57 yr old chronic lower back pain, muscle spasm after PT, hx of substance abuse takes clonidine daily, allergic to amitriptyline, BP 110/70 and gets dizzy when BP runs low, what medication would you use to treat his low back pain?
Baclofen
104
Pt has osteoarthritis in knee, wants to use something everyday, but gets GI upset when taking NSAID, what do you give him?
Topical diclofenac
105
Pt with hx of a dermatomal vesicular rash, and acute neuritis, rash is now crusted over but the pain is moderate to severe, wants something that will work right away, what do you give him?
Capsaicin
106
Pt c/o migraines, you want to treat with 1st line agent but after looking at her medical hx you can’t give her sumatriptan, why not?
Peripheral vascular dx
107
Therapeutic effect of triptans is thought to be what MOA?
5-HT1 receptor agonists, further decrease serotonin from being release
108
78 yo male, DM2, prostate ca, GFR is 25, pt currently taking pregabalin, gabapentin, duloxetine and amazole pt is in need of a local anesthetic to reduce pain what would you use?
Amide local anesthetic (lidocaine (2 Is)) over ester d/t a higher potential for hypersensitivity rxn.
109
Pt comes in c/o pain sensation that has intensified (post herpetic neuralgia )describes the pain as burning, stabbing. Pt has a hx of opioid abuse hx. How do you treat?
Pregabalin
110
At last office visit pt was prescribed pregabalin to help with neuro pain, wants something that will work faster, what do you prescribe?
Capsaicin cream
111
65 yr old women with PD taking C/L increased to 6 x a day d/t end of dose wearing off, you add Entacapone, what is the MOA of Entacapone?
Prolongs L-DOPA and prevents degradation
112
A 74 yr old male comes in for a routine appt, pt has a recent dx of dementia. He takes multivitamin and donepezil. Reports he tolerates the medication well. Daughter believes donepezil is not working. What do you tell her?
Reassure daughter that it is used to help reduce further cognitive deficit, not improve current sxs.
113
A 68 yr old female take donepezil for her moderate dementia early Alzheimer. She lives with son and daughter in law, and they want to keep mom at home for as long as possible what could be added?
Memantine
114
A 78 yr old PD, taking Bromocriptine x10 yrs, drug is now unavailable. What do you give now
Pramipexole
115
A 77 yr old with PD, reports she is attempting to manage his sxs with herbal remedies, however since taking the herbal remedies he reports several ASEs, he was told to d/c supplement to start C/L. What is the MOA?
L-DOPA is converted to dopamine by DOPA decarboxylase in the GI tract in peripheral tissues and within the CNS
116
Pt with AD visits neurologist, states he is having memory issues, requests medication to stop or reverse process. What med would be used 1st for him to help with what?
Restore Ach remission by giving cholinesterase inhibitor like Donepezil.
117
A 35 yr old with early onset of PD, started on C/L, second day of taking the medication he noticed urine discoloration, what do you tell him?
This normal and harmless keep taking
118
A 55 yr old with MS, injects medication for relapsing remitting. What drug do you most likely giving her in a primary care setting?
SSRI and laxatives
119
A 62 yr female w/ MS experiencing a flare up causing loss of vision, weakness, imbalance. What medication is indicated for her flare?
High dose glucocorticosteroids
