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Boards Review > USMLE Neuro > Flashcards

USMLE Neuro Flashcards

1
Q

Critical illness myopathy

A

Critical illness myopathy is characterized by an elevated serum creatine kinase (CK) level. Predisposing factors include the patient’s prolonged ICU stay, use of corticosteroids and neuromuscular junction–blocking agents, and hyperglycemia.

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2
Q

Meningitis

Age 2-50

Age > 50

Neurosurgery shunt

Immunocompromised

Penetrating trauma

A
  • Age 2-50 Vanc + Ceftraisone
  • Age > 50 Vanc + ceftriaxone
  • Neurosurgery shunt : Vanc + cefepime
  • Immunocompromised : Vanc + cefepime + ampicillin
  • Penetrating trauma: Vanc + Cefepime

Cefepime alternative : ceftazidime or meropenem

ampicillin alternative: Bactrim for listeria

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3
Q

Asian patients Siezure meds

A

In an Asian patient with the HLA-B*1502 allele, the risk of Stevens-Johnson syndrome is increased with exposure to carbamazepine, lamotrigine, oxcarbazepine, and phenytoin but not with exposure to levetiracetam.

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4
Q

Bell’s palsy

A

Acute perpheral BP is due to HSV

Start patient on Steriods and Valacyclovir

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5
Q

Brain stem level of medulla oblongata

Brainstem at the level of midbrian

Posterior limb of internal capsule

A

numbness of ipsilateral face / cotralateral body, horners syndrom , gag and cough refles, nystagmus, ipsilateral ataxiawithout any motor symptoms

CNIII nerve palsey, horners, tongue intact, left sided hemiplegia left facial droop

Posterior limb of internal capsule / contralateral weakness numbness with or without facial weakness.

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6
Q

Capgras syndrome

A

delusional misidentification syndrome associated with lesions of the right hemisphere, have the delusion of imposters, believing that important and familiar persons in their lives have been replaced by fraudulent doubles.

Reduplicative paramnesia, in many ways the opposite of Capgras syndrome, is a delusion of familiarity in which a patient in a hospital bed insists that he or she is at home.

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7
Q

Clinical Uses of Amantadine

A
  • Sever Tramatic brain injury
  • Fatigue related to MS
  • Parkinson Dz
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8
Q

Celebral Amyloid Angiopathy

A
  • Second most common cause of Intercrainial bleed in > 75 yrs and older\
  • in the cortical or subcortical areas usually
  • patient get symptoms of stroke and siezures after that
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9
Q

Corticosteroid myopathy

A

presents with predominantly proximal weakness, preserved reflexes, a normal serum CK level, and normal or only mildly myopathic findings on electromyography (EMG).

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10
Q

Cryptogenic Stroke / TIA

Causes?

A

Up to 40 % of the ischemic strokes

  • Foramen Ovale
  • Paroxysmal A-Fib
  • Aortic Arch Atheroma
  • Vasculitis
  • Lacunar infarct
  • Complex migraine
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11
Q

Essential Tremor

A

Tremor with action or posture can happen to voice head, chin, legs

Tx

propranalol or primidone

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12
Q

features of glioblastoma multiforme seen on MRI

A

MRIs, glioblastoma multiforme typically has a ring-enhancing lesion with areas of central necrosis and hemorrhage.

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13
Q

Giant Cell arthritis

A

Fever / Fatigue / weight loss

Unilateral HA

JAw /arm claudication

Visual symptoms

Polymailgia rheumatica PMR

non productive cough

Aortic aneurism or dissection

Dont worry about Berney Start on Steriods then do the bx if negative then do a second Bx biatch ..

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14
Q

Hereditary hemorrhagic telangiectasia

or Osler Weber Rendu

A
  • Freq epitaxis
  • Multiple mucocutaneous telangiectasias
  • Organ involvement (AVMs)
  • First Degree relative with HHT
  • Siezures
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15
Q

How can one reduce neurological injury in post cardiac arrest

A

therapeutic hypothermia induction with in 6 hrs post event and 12-24 hr maintanance

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16
Q

How to treat symptomatic treatments of multiple sclerosis–related fatigue.

related to muscle spasm/stiff ness

Overacitve bladder

A

Amantadine and modafinil are used as symptomatic treatments of multiple sclerosis–related fatigue.

Baclofen (oral or intrathecal pump), tizanidine, cyclobenzaprine, benzodiazepines, carisoprodol, botulinum toxin

Oxybutynin

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17
Q

HSV Encephalitis

A
  • REpeate PCR for HSV fi first negative
  • MRI most sensitive and specific
  • IV acyclovir 10 mg/kg Q8H
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18
Q

Idiopathic intercrainial pressure (psuedotumor Cerebri)

  • Sx
  • Physical E
  • Dx
A
  • HA / Transient vision loss / pulsatile tinnitis
  • Papilledema / prepheral vision defects / CN VI palsey
  • Normal brain imaging / open pressure > 250 mmHg
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19
Q

Manage an unruptured cerebral aneurysm.

A

In the anterior cerebral circulation, the risk of rupture over 5 years is negligible until an aneurysm reaches 12 mm in diameter; in the posterior circulation, the risk of rupture increases as aneurysms become greater than 7 mm.

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20
Q

Cerebral vasoconstriction syndrome

A

Cerebrovascular imaging is used to document reversible cerebral vasoconstriction syndrome, which comprises a group of disorders characterized by recurrent thunderclap headache occurring over a few days or weeks and is associated with transient segmental cerebral vasoconstriction.

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21
Q

Migrain criteria

A

Without Aura

A. At least five attacks fulfilling criteria B-D

B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)

C. Headache with at least two of the following four characteristics:

    1. Unilateral location
    1. Pulsating quality
    1. Moderate or severe pain intensity that inhibits or prohibits daily activities
    1. Aggravation by walking on stairs or similar routine physical activity

D. During headache, occurrence of at least one of following symptoms:

    1. Nausea/vomiting
    1. Photophobia/phonophobia

E. Exclusion of secondary headaches

With Aura

A. At least two attacks fulfilling criteria B and C

B. Headache with at least three of the following four characteristics:

    1. One or more fully reversible aura symptoms indicating focal cerebral cortical and/or brainstem dysfunction
    1. At least one aura symptom that develops gradually over more than 4 minutes, or two or more symptoms that occur in succession
    1. Duration
    1. Headache after aura with an intervening free interval

C. Exclusion of secondary headaches

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22
Q
  • Migraine
  • Tension
  • Medication overuse
  • paroxysmal hmicrania
  • Cluster
A

Migraine

  • Unilateral / Throbbing / N/V photophobia

Tension

  • B/L and non throbbing / gradual onset / Mild to moderate without pericranial muscle tendernss

Medication overuse

  • worsen with daily use of medication

Paroxysmal hemicarania

  • Unilateral throbbing / ipsilateral autonomic symptoms / responds well to indomethacin

Cluster

  • Unilateral in trigeminal region / orbital supraorbital or temporal pain / ipsilateral autonomic symptoms
23
Q

Lithium intoxication
Malignant hyperthermia
Neuroleptic malignant syndrome
Serotonin syndrome

A
  • Lithium intoxication: does not produce hyperthermia
  • Malignant hyperthermia :inherited skeletal muscle disorder = a hypermetabolic state precipitated by exposure halothane, isoflurane, enflurane, desflurane, and sevoflurane
  • Neuroleptic malignant syndrome :exposure to dopamine receptor antagonists and is characterized by muscle rigidity, hyperthermia, cognitive changes, autonomic instability
  • Serotonin syndrome:high fever, muscle rigidity, and cognitive changes
24
Q

Migranes and Kidney stone which drug to avoid

Amitriptyline
Propranolol
Topiramate
Valproic acid

A

topiramate and zonisamide are associated with an increased risk of calcium-containing kidney stones and thus should be avoided in patients with a history of such stones.

25
Q

Meds to prevent of cluster headache

A

Verapamil and oral corticosteroids are effective therapies for the prevention of cluster headache but are not indicated for acute headache treatment.

26
Q

Natalizumab is a disease-modifying therapy for multiple sclerosis that has been associated

A

Natalizumab is a disease-modifying therapy for multiple sclerosis that has been associated with an approximately 1:1000 risk of central nervous system infection with the JC virus, resulting in progressive multifocal leukoencephalopathy.

and liver toxicity

27
Q

Neuro Drugs

  1. Dopamin percursors
  2. Dopamin agonist
  3. COMT inhibitors
  4. Anticholonergics
  5. **MAO inhib - **
A
  1. Levidopa/carbidopa-dizziness,HA, Aggitation
  2. pramipexole/Ropinirole/Bromocriptine - Orthostatic hypotension
  3. Tolcapone/Entacapone - Orthostatic hypotension
  4. Benzotropine - drymout, urinary retention
  5. Amantadine - Livedo reticularis , ankel edema
  6. Selegiline - N / HA
28
Q

Foramen Ovale

What % in population?

How to treat cryptogenic strokes / TIA with this?

A

2025% at autopsy

Anti platlet therapy and Statin

29
Q

normal pressure hydrocephalus: Triad

A

The diagnosis of normal pressure hydrocephalus, which is characterized by the triad of gait impairment, urinary incontinence, and cognitive change, can be suggested by findings on a brain MRI.

30
Q

post tPA

ASA

nicardipine

cryoprecipitate

Nitropruside

A
  • ASA hold for 24 hrs after tPA treatment
  • Nicardipine use if bp >180/105
  • cryoprecipitate and platelet infusion if there is evidence of bleeding
  • ntiropruside is CI in stroke patients
31
Q

POST TPA

CI

A

Avoid ASA for 24 hrs

Start heparin after CT of head r/o bleed after 24 hrs

Do not feed for 24 hrs

Keep BP < 180 SBP that is.

32
Q

Pregnancy & Epilepsy - what to use

A

Carbamazepine is an appropriate antiepileptic drug for women of reproductive age, especially those who are actively pursuing pregnancy.

33
Q

Resting temor

How to treat?

A

Trihexyphenidyl is used when carbidopa/levodopa is not helpful

Amantadine is indicated in treating Levodopa induced dyskenesias and rigidity in patients

Deep Brain Stimulation When therapy fails this is recommended for resting tremor

34
Q

Apnea test

A

The apnea test is considered positive for brain death if the increase in arterial PCO2 is greater than 20 mm Hg (2.7 kPa) without observed respirations.

35
Q

Role of IV heparin or subq LMWH in acute stroke

A

Both are inappropriate - clinical trials have shown no benefit of acute anticoagulation for acute stroke prevention, even in patients with presumed embolic stroke.

36
Q

Anterior Mediastinal tumors

4 most common ones

A

Thymoma

Teratoma

thryoid goiter

Terrible Lymphoma

Thymomas are associated with Myasthenia Gravis

37
Q

Schwannomas manifestations

A

Schwannomas are benign tumors of the nerve sheath that make up 8% of primary CNS tumors. They are extraparenchymal lesions that typically affect cranial nerve VIII and manifest as hearing loss or tinnitus.

38
Q

Seizure treatment:

A

Antiepileptic drugs on ly if patient has had >=2 seizures seprated by 24 hrs and are unprovoked

Valporic acid is not prefered in yyoung women.

Could give lamotrigine / Levetiracetam

39
Q

Short acting Carbidopa / Levodopa

A

Cause Extrapryramidal symptoms

change to long acting

40
Q
  • Site of hemorrhage
  • Basal ganglia
  • Cerebellum
  • Thalamus
  • Cerebral lobe
  • Pons
A

Site of hemorrhage

Basal ganglia

  • Hemiplegia / hemisensory loss
  • Homonymous hemianopsia, Gaze palsy
  • Stupor and coma

Cerebellum

  • Neck stiffness
  • Facial weakness
  • Usually no hemiparesis
  • Stupor or coma from brain stem herniation / look for postural extension/flexion

Thalamus

  • Heiparesis, hemisensory
  • upgased palsy
  • eyes deviated towards hemiparesis

Cerebral lobe

  • Siezures
  • Contralateral homonymous hemianopsia (occipital)
  • Contralater plegia/paresis(frontal lobe)
  • Contralateral heiparesis (partial lob)
  • Eyes diviated from the hemiparesis

Pons

  • Pinpoint reactive pupils
  • Deep coma total paralysis with in minutes oafter hemorrhage
41
Q
  1. interferon SE
  2. Glatiramer SE
A
  1. Flulike symptoms and depression
  2. Skin lipoatrophy
42
Q

temporal lobe epilepsy

uvenile myoclonic epilepsy

A

convulsive seizure with or without an aura can be the initial presentation of temporal lobe epilepsy

Patients with juvenile myoclonic epilepsy have infrequent convulsive seizures often provoked by alcohol or sleep deprivation and can also experience absence seizures and myoclonic seizures that are worse in the morning.

43
Q

The eligibility criteria rtPA

A

Minor or rapidly improving symptoms

Seizure at stroke onset

Other stroke or trauma within 3 months

Major surgery within the last 14 days

History of intracerebral hemorrhage

Sustained blood pressure ≥185/110 mm Hg

Aggressive drug therapy needed to control blood pressure

Suspicion of subarachnoid hemorrhage

Arterial puncture at a noncompressible site within 7 days

Heparin received within the last 48 hours and PTT elevated

INR >1.7

Platelet count

Plasma glucose level 400 mg/dL (22.2 mmol/L)

44
Q
  • Acute angel closure glaucoma
  • Central retinal artery occlusion
  • nonarteritic anterior ischemic optic neuropathy
  • Optic neuritis
  • Retinal detachment
A

Acute angel closure glaucoma

  • Vision loss with sever eyepaind N/V, seeing Halos

Central retinal artery occlusion

  • acute painless, sever vision loss in one eye no pain with movement

Nonarteritic anterior ischemic optic neuropathy

  • painless vision loss, > 50, optic nerve swelling and papiledema

Optic neuritis

Retinal detachment

45
Q

The most appropriate treatment of Bell palsy is —————, preferably administered within the first 72 hours

A

prednisone Oral / (Acyclovir no good evidence for it)

IV methyprednisone is good for MS not bell palsy

46
Q

transient ischemic attacks whose ABCD2 scores

A

3 or mor admit with in 72 hrs

one point for an Age of 60 years or greater

one point for a Blood pressure of 140/90 mm Hg or greater

two points for the Clinical symptom of hemiparesis

two points for Duration of 60 minutes or greater

one point for the presence of Diabetes mellitus

47
Q

Transverse myelitis

A
  • best available evidence supports the use of plasmapheresis and/or cyclophosphamide as rescue treatment for corticosteroid-refractory transverse myelitis.
  • T2-weighted MRI eveals hyperintensity in the spine, which enhances with administration of gadolinium.
48
Q

Treat chronic paroxysmal hemicrania.

A

Chronic paroxysmal hemicrania responds dramatically and specifically to indomethacin.

Chronic paroxysmal hemicrania is a syndrome related to cluster headache that differs in frequency and duration

49
Q

Treatment of MS

A

In a patient with acute optic neuritis and MRI lesions suggestive of demyelination, treatment with intravenous methylprednisolone and disease-modifying agents, such as glatiramer acetate or interferon-beta agents, decreases the short-term risk of multiple sclerosis.

50
Q

What is next for a young patient with convulsive syncope.

A

In a young patient with convulsive syncope, further testing with electroencephalography or MRI is typically unnecessary.

51
Q

Which one is better in elderly

  • Carbamazepine
  • Lamotrigine
  • Oxcarbazepine
  • Phenytoin
A

Lamotrigine

52
Q
A
53
Q
A

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