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Step 2 > Step Up- CNS and PNS > Flashcards

Step Up- CNS and PNS Flashcards

1
Q

Symptoms of a vertebrobasillar stroke

A

dizzyness

double vision

numbness of ipsilateral face and contralateral body

dysarthria

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2
Q

Most common predisposing condition in people with lacunar infarcts

A

HTN

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3
Q

Most common location of origin of embolic strokes

A

Heart

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4
Q

Lacunar infarcts are either pure ______ or pure ______.

A

Either pure motor or pure sensory

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5
Q

What determines if a lacunar infarct is purely motor or sensory?

A

Pure motor– lesion involves internal capsule

Pure sensory– lesion involved the thalamus

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6
Q

Describe the blood flow in subclavian steal syndrome

A

Narrowed subclavian proximal to the vertebral artery

Retrograde flow results in the vertebral artery to supply the subclavian distal to the stenosis

Leads to vertebrobasillar insufficiency

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7
Q

A lack of blood flow to the area supplied by the anterior cerebral artery would result in deficits to these locations

A

Contralateral lower extremity and face

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8
Q

A patient <50 with a stroke should be evaluated for

A

hypercoagulable states:

Protein C

Protein S

antiphospholipid

Factor V leiden

VDRL/RPR, lyme, ANA, ESR

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9
Q

Two common treatments to lower ICP

A

Hyperventilation and mannitol

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10
Q

Order of preferred antithrobotics in stroke (pre-3hr, post etc)

A

If within 3 hours– give t-PA if not contraindicated

If after 3 hours– give aspirin

If allegic to aspirin give clopidogrel–if not possible give ticlopidine

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11
Q

Treatment of patient with asymtomatic carotid stenosis <60%

A

Aspirin and risk reduction

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12
Q

This test is the gold standard to Dx SAH…why?

A

Xanthochromia

yellow color of CSF caused by the breakdown of blood products. Will only be present in patients whom have a bleed.

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13
Q

most common cause of a hemorrhagic stroke

A

HTN or a sudden increase in BP

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14
Q

Shy-drager syndrome

A

parkinsonian symptoms with autonomic insufficiency

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15
Q

Difference between pregressive supranuclear palsy and parkinson

A

PSP does not cause tremors

PSP does cause opthalmoplegia

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16
Q

Use of bromocriptine or pramipexole in parkinson

A

used to decrease the “freezing” that occurs before initiating a movement

Start as soon as diagnosis is establised

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17
Q

Transmission pattern of huntington dz

A

Autosomal dominant

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18
Q

Mutated chromosome and repeat present in huntington

A

Chromosome 4

CAG

Hunting 4 prey using a CAGe

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19
Q

There is a lack of this neurotransmittier in huntington disease

A

GABA in the striatum

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20
Q

MRI finding in huntington disease

A

Atrophy of the caudate

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21
Q

Thiamine deficiency in alcoholics can lead tot his kind of dimentia

A

Korsakoff dimentia

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22
Q

This kind of medication should always be avoided in alzheimer patientes

A

Anticholinergics

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23
Q

Visual disturbances in MS

A

Optic neuritis and intranuclear opthamoplegia

  • monocular vision loss
  • pain on movement of eyes
  • central scotoma
  • decreased pupillary reation
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24
Q

Which two immunomodulating drugs can be used to treat MS? Major side effect?

A

Interferon B-1a and B-1b

Persistent flu-like symptoms

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25
Q

Inflammatory demyelinating polyneuropathy

A

Guillian-Barre

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26
Q

Common infections that preceed gullian barre

A

C. jejuni

CMV

Hepatitis

HIV

Lupus

Hodgkin disease

27
Q

Should steroids be given in guillian barre?

A

NO they are harmful in GBS

28
Q

Ab against this exist in mysthenia gravis

A

Post-synaptic nicotine acytylcholine receptors

29
Q

Imaging study to be performed in myasthenia gravis

A

Chest CT for Thymoma

30
Q

This procedure leads to resolution of symptoms in many patients with mysthenia

A

Thymectomy– even with no known thymoma

31
Q

Steroid recommendations for duchenne muscular dystrophy

A

Boys over the age of 5 with motor deficits should be on steroids

32
Q

Lesions noted in NF1

A

Cafe au lait spots

neurofibromas

CNS tumors

freckling

iris hamartoma (lisch nodules)

bony lesions

Pheochromocytoma

33
Q

Port wine stain with epilepsy and mental retardation

A

Sturge-Weber syndrome

34
Q

Cavernous hemangioma of the brain, renal angiomas and cysts

A

Von hippel-lindau disease

35
Q

Renal lesions associated with VHL

A

Renal cell carcinoma

pheochromocytoma

36
Q

Cape-like distribution of sensory loss

A

syringomyelia

37
Q

Describe brown sequard lesion

A

contralateral loss of pain and temp sensation

Ipsilateral loss of vibratory and proprioception

ipsilateral hemiparesis

38
Q

Difference between central and peripheral vertigo

A

Central: gradual in onset with other neurologic findings

Peripheral: Rapid and severe onset, dependant upon head positioning

39
Q

Triad of meniere disease

A

Vertigo

tinitus

hearing loss

40
Q

Drug of choice for generalized tonic-clonic seizures

A

phenytoin and carbamzepine

41
Q

Drug of choice for absent seizures

A

ethosuxamide or vaproic acid

42
Q

Upper and lower motor neuron signs in a 60 year old patient

A

ALS until proven otherwise

43
Q

Four types od aphasia

A

Wernike

Broca

Conduction

Global

44
Q

Wernike aphasia is characterized by these findings

A

Fluent aphasia

Inpaired comprehension of written or spoken language

Fluent and articulate but words are nonsense becuase patient doesn’t understand what he or she is saying

45
Q

Broca aphasia is characterized by these findings

A

nonfluent

slow speech

meaningful content with broken words

normal comprehension

often associated with right hemiparesis and hemisensory loss

46
Q

Conduction aphasia is characteried by the inability to…

A

repeat phrases, words, sentences

47
Q

Steroids should be used to treat bell palsy except…

A

When Lyme disease is suspected!

48
Q

Name the deficits seen in an MCA stroke

A

Contralteral weakness

Contralateral hanonomys hemianopsia (eyes will deviate towards the lesion)

Aphasia (if dominant hemisphere involved)

49
Q

Name the deficits in an ACA stroke

A

Personality and cognitive deficits

Leg more than arm weakness

Urinary incontinence

50
Q

Deficits in PCA stroke

A

Ipsilateral sensory loss on the face (9th and 10th CN as well)

Contralateral sensory loss on limbs

Limb ataxia

51
Q

What is the treatment for a patient with an ischemic stroke who is already on aspirin?

A

Add dipyrimidole

or

Add clopidogrel

52
Q

Target LDL for a patient with carotid stenosis

A

<100

53
Q

Physical exam findings in pseudotumor cerebri

A

Papilledmea with doplopia from CNVI (abducens) deficit

54
Q

Treatment for pseuotumor cerebri

A

Acetazoleamide to decrease CSF production

55
Q

Prophylaxis and treatment for cluster headaches

A

Prophylaxis: verapamil

Treatment: 100% O2 is abortive, also prednisone and lithium

56
Q

Prophylactic therapy for recurrent migranes

A

Propanolol

57
Q

Tx for trigeminal neuralgia

A

oxcarbazepine

or

carbamazepine

58
Q

Treatment for pain of posterherpetic neuralgia

A

TCA

Gabapentin

pregabalin

carbamazepine

phenytoin

59
Q

indications for zoster vaccine

A

all persons over the age of 60

60
Q

Treatment for status epillepticus

A

Benzo

or phenytoin or fosphenytoin

61
Q

Side effect of phenytoin? Why?

A

AV block and hypotension

because it is a class1b antiarrythmic

62
Q

What is the last line agent to stop seizing?

A

Neuromuscular blockage with vecuronium or succinylcholine and then general anesthsia

63
Q

Order of treatment in status epillepticus

A
  1. benzo
  2. fosphenytoin
  3. phenobarb
  4. Neuromuscular blockade

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