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Neurology USMLE Step 3 > Section 10: CNS Miscellaneous > Flashcards

Section 10: CNS Miscellaneous Flashcards

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USMLE® Step 1 flashcards
1
Q

What does Broca’s (expressive) aphasia involves?

A

Broca’s (expressive) aphasia involves:

  • Nonfluent speech
  • Good auditory comprehension; and
  • Poor repetition and naming
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2
Q

How does stroke involving the superior division of the middle cerebral artery present?

A
  • Contralateral hemiparesis that affects the face, hand, and arm
  • Contralateral hemisensory deficit in the same distribution
  • Iipsilateral gaze preference
  • Facial droop
  • If the dominant hemisphere is affected, Broca’s aphasia results
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3
Q

How does stroke involving the inferior division of the middle cerebral artery present?

A
  • Contralateral homonymous hemianopia
  • Neglect of the contralateral limbs
  • Apraxia
  • If the dominant hemisphere is affected, Wernicke’s aphasia results.
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4
Q

What does Wernicke’s (receptive) aphasia involves?

A

Wernicke’s (receptive) aphasia involves:

  • Fluent speech
  • Poor auditory comprehension
  • Poor repetition and naming
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5
Q

What is the presentation of anterior cerebral artery (ACA) stroke?

A

Leg paresis

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6
Q

What is the presentation of posterior cerebral artery (PCA) stroke?

A
  • Homonymous hemianopia with macular sparing
  • Prosopagnosia (inability to recognize familiar faces)
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7
Q

How does basilar artery stroke present?

A
  • Coma
  • Cranial nerve palsies
  • “Locked-in” syndrome
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8
Q

How does lacunar stroke present?

A
  • Pure motor or sensory deficit
  • Dysarthria – clumsy hand syndrome
  • Hemiparesis involving face, arm and leg
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9
Q

What is the most effective way to reduce aspiration in stroke or in a ptc with swallowing dysfunction

A

Upright supine position

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10
Q

When to start fibrinolytic therapy in stroke patient?

A
  • First 3 to 4.5 hours following symptom onset
  • CT scan should be done first to r/o intra-cranial hemorrahge
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11
Q

How to Rx stroke patient who came in after 6h?

A
  • Aspirin
  • Control HTN
  • Swallow evaluation before giving any oral meds
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12
Q

Inclusion criteria for IV recombinant tPA (thrombolytics)

A
  1. Symptom duration of 4.5 hours
  2. Age > 18 years
  3. CT scan without hemorrhage
  4. A diagnosis of ischemic stroke, and
  5. A measurable neurologic deficit.
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13
Q

What is the permissible BP for stroke ptc who are tPA candidates

A

185/110 mmHg

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14
Q

What is the permissible BP for stroke ptc who are not tPA candidates

A

>160/>80 mmHg

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15
Q

Why is ASA (aspirin) important in acute ischemic stroke?

A

ASA reduces the incidence of a second event

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16
Q

For ptc already on ASA with acute iscemic strokes, what other antiplatelet medications should be given?

A

Clopidogrel, ticlopidine, or dipyridamole

17
Q

What are the exclusion criteria for use of tPA in pt with acute ischemic stroke?

A
  1. Stroke or head trauma within the prior three months
  2. A history of intracranial hemorrhage
  3. Major surgery within two weeks
  4. Acute MI within the past three months
  5. LP within seven days
  6. Uncontrolled hypertension requiring aggressive therapy
  7. Pregnancy or lactation
  8. Evidence of cerebral hemorrhage.
18
Q

Patients with basilar artery thrombosis may receive intra-arterial tPA up to how many hours after symptom onset?

A

Six hours

19
Q

What measures can be taken to prevent (ischemic) stroke?

A
  1. Antiplatelet therapy: ASA, ASA/dipyridamole (Aggrenox), or clopidogrel (Plavix)
  2. BP goals: Treat most patients to 130/80
  3. Lipid goals: Treat patients to an LDL of 100 mg/dL
  4. The HbA1c goal is 7%
  5. Discontinue smoking
  6. Encourage physical activity
  7. If > 50% carotid stenosis is seen on angiography, consider carotid endarterectomy
  8. If AF is present or if the LVEF is ≤ 25%, consider warfarin
20
Q

What is best initial test for a ptc with stroke?

A

CT scan of the head without contrast to rule out hemorrhage

21
Q

What does MRI with diffusion-weighted imaging (DWI) show?

A

DWI shows dying tissues

22
Q

What does MRI with perfusion-weighted imaging (PWI) show?

A

PWI shows penumbra, that is tissues at risk of dying.

23
Q

What is the role of MRA or CT angiography in stroke patients?

A

To evaluate vessels including the carotids and circle of Willis

24
Q

What is the role of Transesophageal echocardiography (TEE) in stroke patients?

A

To evaluate for cardiac emboli and patent foramen ovale

25
Q

Enumerate the tests to be conducted for stoke ptc

A
  • CT
  • MRI with DWI or PWI
  • MRA or CT angiography
  • TEE
  • CBC
  • Electrolytes
  • Coagulation studies
  • HbA1c
  • Lipid profiles
  • ECG or telemetry
26
Q

For hemorrhagic stroke, what should be the ideal BP?

A

Keep BP at less than 160 systolic unless ICP is very high

27
Q

Name some medications associated with seizure

A
  • Imipramine
  • Meperidine
  • INH
  • Metronidazole
  • Bupropion
  • Fluoroquinolones
28
Q

First line drugs for the prevention of partial seizures

A
  • Carbamazepine
  • Lamotrigine
  • Phenytoin
  • Valproate
29
Q

First line drugs for the prevention of primary generalized seizures

A
  • Valproate
  • Lamotrigine
30
Q

First line drugs for the prevention of absence seizures

A
  • Ethosuximide
  • Valproate
31
Q

First line drugs for the prevention of myoclonic or atonic seizures

A

Valproate

32
Q

List the signs and symptoms of elevated ICP

A
  • Headache on awakening
  • Nausea/vomiting
  • Drowsiness
  • Diplopia
  • Blurry vision
  • Papilledema
  • CN VI palsies.
33
Q

Enumerate the clinical criteria for brain death

A
  1. A comatose state (unresponsiveness to verbal, tactile, or painful stimuli)
  2. Absent pupillary light, corneal, oculovestibular (tested by cold calorics), and gag reflexes
  3. Absent motor responses to painful stimuli
  4. Complete apnea denoted by no respirations at a PaCO2 of 60 mm Hg, or 20 mm Hg above normal values
  5. Exclusion of sedative medications, hypothermia, hypotension, or metabolic derangements.
34
Q

What is the shape of epidural hematoma?

A

Biconvex

35
Q

What is the shape of subdural hematoma?

A

Crescentic

36
Q

List and explain the signs in skull fracture

A
  • Battle’s sign (ecchymosis over the mastoid process)
  • Raccoon eyes (periorbital ecchymosis)
  • Hemotympanum
  • CSF rhinorrhea/otorrhea.
37
Q

Danger signs for headache

A
  • Change in frequency or severity
  • Fever
  • Neurologic signs
  • New-onset headaches
38
Q

When to obtain a CT scan for headache?

A
  • If the headache is acute and extremely severe (“thunderclap headache”)
  • If the headache is progressive over days to weeks, particularly if it is not similar to previous headaches
  • In the presence of focal neurologic signs
  • In the setting of papilledema
  • If the headache has a morning onset or awakens the patient from sleep.

Neurology USMLE Step 3 (10 decks)

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