uworld 1 Flashcards
can craniopharyngiomas be in adults?
yes, 50% are over 20
sellar mass presentation
diplopia, bitemporal hemianopsia, vision loss
HA
hormonal def
painful vision loss with abnormal pupillary response to light. think…
optic neuritis
pathophys of normal pressure hydrocephalus
decreased CSF absorption at villi or obstruction
or transient ICP increase –> ventricular expansion –> pressure returns to normal
type of gait in NPH
slow, broad-based/wide shuffling gait
preferred imaging for suspected stroke
noncontrast CT
when do hemorrhagic strokes and ischemic strokes appear on CT?
hemorrhage: immediately
ischemic: after 24 hrs
first step for patient with cognitive impairment
neurocognitive testing
what is this: 57 yo male with HTN, CAD has motor hemiparesis and UMN signs
lacunar stroke in internal capsule
pathophys of lacunar stroke
occlusion of deep penetrating arteries
microatheroma and lipohyalinosis –> thrombosis
are lacunar strokes on noncontrast CTs?
no, dont show up
when can IV alteplase be used for ischemic strokes?
within 3.5-4 hrs
preferred treatment for ischemic strokes after 4 hours with no prior antiplatelet therapy
aspirin
preferred treatment for ischemic strokes if on aspirin already?
aspirin + dipyrimadole OR clopidogrel
preferred treatment for strokes with evidence of afib?
long term anticoagulation (warfarin, dabigatran, rivaroxaban)
are there sensory impairments in lacunar stroke?
no
MCA occlusion
contralateral sensory deficit contralateral motor deficit homonymous hemianopsia conjugate eye deviation toward side of infarct aphasia hemineglect
ACA occlusion
contra sensory deficit contra motor deficit (esp. lower) abulia (lack of will) dyspraxia, emotional disturbance urinary incontinence
vertebrobasilar lesion
contralateral hemiplegia
ipsilateral CN palsies
ataxia
occlusion of internal carotid would affect which arteries
MCA and ACA
PCA stroke
homonymous hemianopsia alexia without agraphia visual hallucinations 3rd nerve palsy contralateral motor deficits
Lambert Eaton associated with
underlying malignancy (small cell lung cancer)
Lambert Eaton pathophys
autoantibodies against voltage gated Ca channels in presynaptic motor neuron
Lambert Eaton presentation
proximal muscle weakness
autonomic dysfunction (dry mouth)
CN nerve involvement
diminished or absent deep tendon reflexes
dermatomyositis/polymyositis presentation
proximal muscle weakness
polyarthritis
esophageal dysmotility, raynaud, interstitial lung dz
heliotrope rash in derm
is GBS ascending or descending?
ascending
GBS on CSF
high protein
normal WBC, RBC, glucose
GBS treatment
IVIG, plasmapharesis
1st step after adult has first seizure
rule out metabolic causes with labs!
CBC, CMP, glu, Ca, Mg, renal/liver tests, urine drug screen
then once ruled out, EEG
most common fatal sporadic encephalitis in the US
herpes encephalitis
herpes encephalitis presentation
focal neuro findings
fever
behaviroal changes
herpes encephalitis on CSF
high lymphocytes
high RBCs (hemorrhagic destruction of temporal lobe)
high protein
gold standard for diagnosis of herpes encephalitis
**PCR HSV DNA in CSF
others: MRI>CT
altered brain status- meningitis or encephalitis?
encephalitis only
when does pain/temp diminish in brown sequard relative to lesion
1-2 levels below cord injury
