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Neuro Shelf > Step 2 CK stuff > Flashcards

Step 2 CK stuff Flashcards

1
Q

4 Deadly Ds of posterior circulation strokes

A

Diplopia
Dizziness
Dysphagia
Dysarthria

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2
Q

Stroke labs

A

CBC, PT/PTT, cardiac enzymes and troponin, BUN/Cr

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3
Q

Lateral corticospinal

A

movement (ipsilateral) limbs and body

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4
Q

Dorsal column/medial lemniscus

A

fine touch, vibration, proprioception (ipsilateral)

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5
Q

Spinothalamic

A

pain & temp (contralateral)

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6
Q

ALS treatment pharm?

A

For Lou Gehrig give NILOUZOLE

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7
Q

Bell’s Palsy is complication of?

A

ALexander Bell with STD

AIDS, Lyme, Sarcoidosis, Tumors, DM

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8
Q

Babinksi is sign of …?

A

UMN problem but normal in first year of life

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9
Q

Reflex nerve roots? (achilles, patella, triceps, biceps)

A 
Achilles S(1),2
Patella L3,(4)
Biceps C(5),6
Triceps C(7),8
(root in parenthesis)
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10
Q

Stroke thrombolytics (tPA)?

A

For ischemic (which is 80% of strokes)
If within 3-4 hours
And you can tell if it’s ischemic with CT without contrast (but may see nothing if

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11
Q

MCA stroke CHANGes?

A 
Contralateral paresis and sensory loss (face and arm)
Hemiparesis
Aphasia (dominant)
Neglect (nondominant)
Gaze preference (toward side of lesion)
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12
Q

If more >3 hours since ischemic stroke?

A

Give ASA, or clopidogrel if already taking ASA

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13
Q

Contralateral paresis and sensory loss in le, with personality changes?

A

ACA stroke

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14
Q

Vertigo and homonymous hemianopsia?

A

PCA stroke

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15
Q

Stroke symptoms that are pure motor, pure sensory, dysarthria, ataxic hemiparesis?

A

Lacunar stroke

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16
Q

If neuro sx (can be any kind) last LESS than 24 hours (often

A

TIA

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17
Q

SAH LP findings (if CT without contrast is negative)?

A

RBCs, xanthochromia, incr protein, incr ICP

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18
Q

If SAH suspicion and CT plus LP are negative?

A

Do noninvasive angiography

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19
Q

“Blown pupil” suggests?

A

Ipsilateral brainstem compression

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20
Q

Vessels ruptured in subdural vs epidural hematoma?

A

Subdural: bridging veins (blood between dura and arachnoid)
Epidural: tear of middle meningeal artery (blood between skull and dura)

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21
Q

Seizure definition?

A

Sudden changes in neurologic activity due to abnormal electrical activity in the brain that can often be detected by EEG

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22
Q

Uncontrollable twitching while fully aware. Think what?

A

Simple partial seizure

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23
Q

Lip smacking with impaired LoC and followed by confusion. Think what?

A

Complex partial seizure

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24
Q

Simple vs complex partial seizure?

A

Simple has no impaired level of consciousness (and partial meas that it comes from abnormal activity in a discrete region so can have a variety of features dependent on where)

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25
Q

Majority of complex seizures originate in?

A

Temporal lobe (70-80%)

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26
Q

Generalized vs partial seizure?

A

General involves BOTH cerebral hemispheres (rather than a discrete area) and result in impaired LoC

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27
Q

Tonic-clonic (ie grand mal) generalized distinguished by?

A

Sudden loss of consciousness
Extension of back and contraction/relaxation of muscles
Incontinence & tongue biting
Postictal cyanosis, confusion, drowsiness

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28
Q

Postictal state in absence epilepsy (petit mal)?

A

None

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29
Q

First line anticonvulsant for kids?

A

Phenobarbital

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30
Q

Childhood absence EEG finding?

A

3-per-second spike and wave discharge

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31
Q

Tonic-clonic EEG finding?

A

10 Hz activity

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32
Q

Partial seizure EEG finding? Next step?

A

Discrete epileptogenic focus. If focal seizures are found, get a CT or MRI (with contrast) to check

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33
Q

Normal EEG during seizures. Think what?

A

Pseudoseizure

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34
Q

Absence seizures - first and second line?

A

First: ethosuximide
Second: valproic acid

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35
Q

When to start treatment/diagnostics for status epilepticus?

A

seizures >5 min

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36
Q

Order of status epilepticus diagnostics?

A
  • H&P and labs
  • Continuous EEG if nonconvulsive SE suspected or pt not waking up after observable seizures stop
  • stat head CT if IC pathology suspected
  • LP after safe CT, if fever or meningeal signs
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37
Q

Status epilepticus treatment?

A

1) ABCs
2) thiamine then glucose and naloxone (for rapid tx of potential etiologies)
3) IV benzo at 0-5 and 5-10 min
4) If still seizing at 20 min: FOSPHENYTOIN, other anticonvulsants, or continous IV midazolam

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38
Q

Vertigo red flags

A

Nystagmus for >1 min, gait disturbance, vomiting

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39
Q

Vertigo and vomiting 1 week after viral infection?

A

acute vestibular neuritis

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40
Q

Vestibular neuritis vs labyrinthitis (with similar presenters)

A

Labyrinthitis has auditory or aural sx - lateral PONTINE/CEREBELLAR strokes, similar pres

(VN does not - lateral Medulla/Cerebellar strokes similar pres)

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41
Q

Vertigo treatment

A

steroids

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42
Q

Recurrent vertigo with auditory sx, n/v, progressive low frequency hearing loss?

A

Meniere’s dz

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43
Q

Meniere’s tx?

A

Acute: meclizine or benzos, and antiemetics
Chronic: limit salt intake

44
Q

Cardiac vs noncardiac syncope? Then to be sure?

A
  • Noncardiac has prodromal sx (eg, warmth, nausea, sweating), cardiac does not
  • Unless it is clearly vasovagal in young pt do EKG with troponins and eznymes, plus Holter monitor or telemetry
45
Q

Myasthenia Gravis vs Lambert Eaton Myasthenic syndrome

A
  • Gravis is Ab to post synaptic ACh-R, worst at end of day, treated with ACh-esterases, then immune treatment
  • Syndrome is Ab to presynaptic Ca channels, gets better through day, and treated with 3,4-diaminopyridiane and guanidine plus immune tx
46
Q

Lambert Eaton Myasthenic syndrome assoc with?

A

Small cell lung cancer

47
Q

MS Charcot’s triad?

A

scanning speech, intranculear opthalmoplegia, nystagmus

48
Q

MS type with best prognosis?

A

relapsing and remitting

49
Q

Administration of corticosteroids for optic neuritis?

A

IV not oral

50
Q

MS MRI and LP findings?

A

MRI: (best) multiple, asymmetric, periventricular white matter lesions, esp. corpus callosum, ehnace with gadolinium
LP: incr IgG in CSF and at least 2 oligocolonal bands (not found in serum)

51
Q

MS treatment?

A

Acute: high dose IV steroids, then PLEX if poor response
Chronic: immunomodulators

52
Q

ABC of MS immodulator tx?

A

A - Avonex/Rebif (INF B1a)
B - Betaseron (INF B1b)
C - Copaxone (Copolymer-1)

53
Q

MS symptomatic tx?

A

Anticholinergics for urinary incontinence
Baclofen for spasticity
Cholinergics for urinary retention
anti-Depressants
plus Carbamazepine and amitripyline for painful paresthesias

54
Q

Four “A”s of Guillain Barre?

A

Acute inflammatory demyleinating polyradiculopathy
Ascending paralysis
Autonomic neuropathy
Albuminocytologic dissociations (i.e. incr albumin in CSF)

55
Q

Guillain Barre diagnx?

A

decr nerve conduction velocity and CSF protein >55 mg /dL

56
Q

Guillain Barre tx?

A

PLEX and IVIG, NOT steroids

with AGGRESSIVE PT rehab

57
Q

55 yr old man: slow progressive and ASSYMETRIC UE weakness assoc with fasciculations and atrophy but NO bladder disturbance, normal cervical MRI?

A

ALS

58
Q

What is bulbar onset ALS?

Suggests pathology where?

A

Presents with difficulty swallowing, speaking and loss of tongue movement
Suggests pathology above the foramen magnum

59
Q

UMN signs?

A

Weakness in arm extensors and leg flexors
Spastic (incr.) tone
HYPERreflexia
Plus: Babinski reflex and pronator drfit

60
Q

LMN signs?

A

Weakness is variable
Flaccid (decr.) tone
HYPOreflexia
PLus: Atrophy and fasciculations

61
Q

D.E.M.E.N.T.I.A.S. Ddx?

A 
neuro-Degenerative
Endocrine
Metbolic
Exogenous
Neoplasm
Trauma
Infection
Affective disorder
Stroke/Structural
62
Q

Dyspraxia

A

difficulty with learned motor tasks

63
Q

Drugs that slow decline in Alzheimer’s (mild-moderate vs moderate-severe)?

A

mild-mod: donepezil (cholinesterase inhib)

mod-severe: memantine (NMD-R antagonist)

64
Q

Abrupt changes in dementia sx over time rather than gradual?

A

Vascular dementia

65
Q

Three “W”s of NPH?

A

Wet (incontinence)
Wobbly (gait apraxia) - “feet glued to floor”
Wacky (dementia)

66
Q

Two dementia with ventricular enlargement?

A

Alzheimer

NPH

67
Q

Possible treatment for NPH?

A

LP or continuous lumbar CSF drainage (for several days)

If that works then surgical ventriculo-peritoneal shunting

68
Q

MMSE score threshold when it’s probably no longer normal aging if below?

A

24

69
Q

Rapidly progressing dementia with myoclonus?

A

CJD

70
Q

Elevated CSF proteins in CJD?

And that indicates?

A

14-3-3 and tau

Indicates rapid destruction of neurons

71
Q

Dementia with cognitive, movement, and psychiatric sx?

A

Lewy body

72
Q

Huntington’s sx tx?

A

Reserpine and tetrabenazine for movement
Atypical antipsychotics for psychosis
SSRIs for depression

73
Q

Essential tremors vs Parkinsonian tremors

A
  • essential are suppressed at rest, unlike parkinson
  • essential more likley to be bilateral then early parkinson
  • essential can be the only sx
74
Q

Essential tremor tx?

A

Propranolol
Primidone
Topiramate

75
Q

Gait changes in NPH vs Parkinson?

A

NPH preserves arm swing

76
Q

The Parkinson T.R.A.P.?

Plus the 3 “M”s?

A 
Tremor (pill roll)
Rigidity (cogwheel)
Akinesia/bradykinesia
Postural instability
- masked facies, memory loss, micrographia
77
Q

Parkinson tx: ankle edema and livedo reticularis? What drug?

A

Amantadine

78
Q

Levodopa/carbidopa

A

hallucination, dizziness, HA, agitation, then involuntary movement

79
Q

DZ with dopamine defic and ACh excess?

A

Parkinson

80
Q

DZ with ACh and NE defic?

A

Alzheimer

81
Q

DZ with blocked ACh activity?

A

Myasthenia gravis

82
Q

Proportion of intracranial neoplasms that are primary vs metastatic?

A

30% primary

70% mets

83
Q

Common primary cancers that met to brain?

Location of brain mets?

A

lung, breast, kidney, GI, melanoma

Mets at gray-white junction

84
Q

Most common primary CNS tumors in adults?

A

glioblastoma multiforme

meningioma

85
Q

Most common primary CNS tumors in kids?

A

astrocytoma

medulloblastoma

86
Q

3 types of astrocytoma and which is benign?

A

diffus (benign)
anaplastic (malignant)
gliobalstoma (malignant)

87
Q

ICP management (5)

A 
Elevate head
Hyperventilate (decr CO2 -- cerebral vasoconstriction)
Corticosteroids
Mannitol
Removal of CSF
88
Q

Symptoms of incr ICP (4)

A

Nausea
Vomiting
Diplopia
HA (worse in morning and with bending over or lying down)

89
Q

Ages that NF1 and NF2 are evident?

And both are inherited AR or AD?

A

15 and 20

AD

90
Q 
NF1 diagnx (2 or more of this 7)?
aka von Recklinghausen
A
  • 6 cafe au lait
  • 2 neurofibromas
  • freckling in axillary/inguinal areas
  • optic glioma
  • 2 Lisch nodules
  • Bone abnormality
  • first degree relative with NF1
91
Q

NF2 diagnx?

A

Bilateral acoustic schwannomas
OR First degree reltive with NF2 and either:
- unilateral acoustic schwannoma
- or 2 neurofibromas, meningiomas, gliomas, schwannoma
Plus possible seizures, skin nodules, cafe au lait spots

92
Q

Tuberous sclerosis (inheritance, presentation)

A

AD, infantile spasms/seizures
ASH LEAF hypopigmented lesions
Mental disability
Small benign tumors on skin, CNS, heart , retina, kidneys

93
Q

Motor aphasia, expressive aphasia, nonfluent aphasia?
Localization?
Aware?

A

Broca’s (posterior inferior frontal lesion on dominant side)

AWARE of PROBS

94
Q

Sensory aphasia, receptive aphasia, fluent aphasia?
Localization?
Aware?

A

Wernicke’s aphasia
(posterior superior (perisylvian) temporal lesion on dominant side)
UNAWARE of PROBS

95
Q

Impaired on intact repetition in aphasia?

A

Impaired in true Broca and Wernicke

If intact then lesion is around the Broca area (transcortical motor apahasia - TMA) or Wernicke (TSA)

96
Q

Broca’s aphasia often 2/2 what stroke?

A

Left SUPERIOR MCA

97
Q

Wernicke’s aphasia often 2/2 what stroke?

A

Left INFERIOR/POSTERIOR MCA

98
Q

Coma is caused by dysfunction of?

Due to?

A

Dysfxn of both cerebral hemispheres brainstem (pons or higher)
Due to structural or toxic-metabolic insults

99
Q

Coma Initial treatment

A

1) Stabilize (ABCs)
2) Reverse (with D.O.N.T.
- dextrose, oxygen, naloxone, thiamine)
3) Identify (and treat underlying cause)
4) Prevent (further damage)

100
Q

Order of imaging for coma

A

1) CT without contrast (checking for hemorrhage and structural changes), before LP
2) MRI

101
Q

Paralyzed but wakeful and alert, able to move eyes and eyelids?

A

Locked in syndrome

102
Q

Wakefulness WITHOUT alertness?

A

pVS

103
Q

No sleep-wake cycles WITH resp drive?

And WITHOUT?

A

Coma

Brain death

104
Q

Wernicke encephalopathy and Korsakoff dementia - are they reversible?

A

Wernicke - yes! With thiamine

Korsakoff - no.

105
Q

Closed angle vs open angle glaucoma bilateral or unilateral?

More common?

A 
Closed unilateral
Open bilateral (more common)
106
Q

Headaches triggered by dark/bright light?

A

Dark: closed-angle glaucoma (due to pupillary dilation)
Bright: migraines

107
Q

Cataracts assoc with?

A

DM, HTN, Age, radiation exposure

Neuro Shelf (3 decks)

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