Week 5 Flashcards
what drugs dilate the eye
alpha angonists! like epinephrine etc.
what drugs constrict the pupil
any parasympathetic activators (pilocarpine)
describe parinaud syndrome
vertical gaze palsy, nystagmus, pupils that accomodate but do not react, eyelid retraction when looking up
what is the most common malignant brain tumor in children
medulloblastoma
how do meningiomas appear on T2 weighted MRI
hyperintense bordered well circumbscribed lesion
what is the order you give glucose and thiamine for wernicke encephalopathy
thiamine AND THEN glucose
what is commonly associated with paraplegic people
decubitous (positional) ulcers, treat with wound care and surgical debriedement if severe
what is neurogenic shock
this is when you have loss of all sympathetic tone and you have no sympathetic drive. So you have low HR, low BP, low RR, and flushed skin
what do you use to treat AIP exacerbations
hemin, glucose is for minor attacks
what is cabergoline
dopamine receptor agonists used for prolactinoma
manifestations of neuroleptic malignant syndrome
rigidity, high temp, hyporefflexia, leukocytosis, elevated creatinine kinase, diaphoresis
signs of ICH due to cerebral amyloid angiopathy on imaging
CAA can cause silent micro bleeds so you will see past hemorrhages.
besides bracing, what else do you do for treatment of carpal tunnel syndrome
corticosteroid injections
how do you treat SIADH
give hypertonic saline
in H flu meningitis what is a big complication
hearing loss!
what kind of bacteria is h flu
gram neg rod
what is a common cause of syncope in older adults that also have shortness of breath
aortic stenosis
what is first line treatment of restless leg syndrome
gabapentin! ropinerole is resevered for refractory RLS
for AIP what are common drugs that cause exacerbations
anything that induces CYP 450 enzyme synthesis because these enzymes contain heme products and so it depletes the heme
what drugs to you give for tardive dyskinesia
benztropine or trihexyphenidyl
how do you treat internal carotid dissection
short term heparin
CSF in a GBS patient
normal glucose, elevated protein, no cells
when can you not give propanolol
patients with asthma
when can hemorrhagic conversion occur
within the first 24-48 hours
what is a common lesion in patients who wear lots of high heels
intermetatarsal neuroma
what is otosclerosis
this is when you have fixation of the stapes to the oval windo which causes conductive hearing loss
signs of otosclerosis
hearing better in loud environments, bilateral negative Rinne test
C5 sensory, motor and reflex changes
senory: deltoid // motor: deltoid and biceps // reflex: loss of biceps
C6 sensory, motor and reflex changes
sensory: radial arm and thumb // motor: biceps and brachioradialis // reflex: biceps
C7 sensory, motor and reflex changes
sensory: middle finger // motor: radial nerve (triceps, wrirst extensorys and flexors, pec major) // reflex: loss triceps
C8 sensory, motor and reflex changes
sensory: pinky and ring finger
L3 sensory, motor and reflex changes
sensory: n/a // motor: quads // reflex: patellar
L4 sensory, motor and reflex changes
sensory: medial leg below knee and medial malleolus // motor: quads and anterior tibial // reflex: patellra
L5 sensory, motor and reflex changes
sensory: dorsum of foot to great toe // motor: hallucis longus, extensor digitorum longus
S1 sensory, motor and reflex changes
sensory: lateral foot // motor: plantar flexion, toe flexion // decreased achilles reflex
how do you diagnose a plexopathy
EMG
what does Right sided heart failure look like
peripheral edema!!!
how do you differentiate between a craniopharngioma vs. pit adenoma on imaging
a cranio. will be calcified on imaging
If someone is an IV drug user and they have back pain what is likely happening
they likely have an abcess so they need antibiotics
what is happening in spinal muscular atrophy
destruction of the anterior horn cells I.e. lower motor neurons
what is conversion disorder
neurological symptoms in times of stress that arent caused by any structural deficits
what medication can you use for menieres disease
hydrachlorothiazide
what type of brain bleed do people have that have a longer period without any major neurological deficits
subdural hematoma
when is carpal tunnel syndrome worse and what is it relieved by
worse at night relieved by shaking hands
if a patient has referred pain to the butt where is the lesion
lumbar nerve root
describe risperidone
it is a second gen antipsychotic and has greater D2 antagonism than most antipsychotics so it can exacerbate parkinsonism in parkinsons patients
what is a functional tremor
tremor that is exacerbated by stress and can stop and start
how do you treat catatonia
you give a benzo
is forced vital capacity decreased in an ALS patient
yes its decreased
signs of myotonic dystrophy in an adult
myotonia and weakness, excessive daytime sleepiness, pharyngeal weakness, hypogonadism, frontal balding etc.
myotonic dystrophy inheritance
autosomal dominant CTG repeat disorder
signs of frontotemporal dementia
early personality changes, and hyperorality, no focal neurological deficits
what is cranial nerve III palsy look like
pupil is abducted so its going out of the head because it cannot be adducted
how do you treat migraines in children
NSAIDS
if a patient lesions the left hypoglossal nerve which way does the tongue go
it goes to the left! I.e. same side of the lesion
where are neuroblastomas often located
in the cervical spinal cord
if the patient has a stroke in the pons what kind of facial nerve palsy will be seen
lower motor neuron! so whole side of the face is paralyzed
signs of cervical radiculopathy
radiating pain to the shoulder or arm, pain when turning head, motor/sensory/dermatomal findings
causes of cervical radiculopathy
spondylosis (elderly) which is osteophyte formation
glucose level that causes hyperosmolar hyperglycemia
> 600
what can give you toxic neuropathy
alcohol, medications, heavy metals
what is in the CSF if someone has CJD
14-3-3 protein titer
signs of wound botulism
facial weakness/neck weakness, longer time till onset (toxin is not preformed)
if someone has carotid artery stenosis do you have to put them on antiplatelet and statin
yes
signs of carotid artery dissection
hx of trauma to the neck, hemiplegia, aphasia, neck pain, headache
what can diminish sensitivity of the MMSE
education level
what do you do for treatment of tourrettes
often just counseling and watchful waiting
are cafe au lait spots hypo or hyper pigmented
they are hyperpigmented
what is an electrolyte imbalance seen in AIP vs. lead toxicity
AIP will show hyponatremia too
treatment for intracerebral hemorrhage
urgent surgical decompression
signs of central hernation
decorticate –> decerebrate posturing, bilateral mid sized fixed pupils,
signs of hyperorality
putting things in the mouth (cigarettes common)
what drug do you give to dementia patients
anticholinergic like donepezil, rivastigmine, galantamine
pharmacologic management for FTD
SSRIs!
where is the median nerve trapped if the patient only has sensory loss in ther finger tips
carpal tunnel
signs of bilirubin neurotoxicity in a newborn
choreathetoid movements, hypotonia, lethargy, sensorineuronal hearing loss, upward gaze palsy
causes of bilirubin neurotoxicity
forceps delivery, prematurity, hemolysis, exclusive breatfeeding
what is the cause of bilateral trigeminal neurlagiaI
MS!
what predisposes you to compression neuropathies
diabetes, pregnancy, obesity, etc.
signs of ulnar nerve entrapment at the elboy
paresthesias and pain of the firth and fourth digit, weakness and atrophy of FDI ADM
signs of radial nerve compression
triceps weakness, wrist drop, dorsal aspect of hand sensory loss
etiology of compression of the radial nerve
spiral groove fracture, compression at axilla. triceps spared in spiral groove fracture
femoral neuropathy signs
leg weakness with standing and walking, anterior thigh pain, diminished patellar reflex
femoral neuropathy etiology
surgery, childbirth, DM
peroneal neuropathy signs
foot drop, minimal sensory complaints
is there pain associated with GBS?
yes! typically back or leg pain
CIDP muscle weakness
symmetrical and upper and lower limbs
signs of hyperkalemic periodic paralysis
episodes fo generalized weakness lasting mintues to hours
signs of hypokalemic paralysis
episodes of generalized weakness lasting hours to days
signs of myotonic dystrophy
distal muscle weakness and stiffness, myotonia, systemic features
how do you treat a myasthenic crisis
intubation, IVIG, plasmapharesis
signs of dermatomyositis
symmetric proximal limb weakness, dysphagia, myalgias, arthralgias, interstitial lung disease, face rash
valproate use
first line for generalized tonic clonic seizures, can be used for absence if needed too
valproate AE
teratogenic, tremor, alopecia, weight gain
carbamazapine spectrum
first line for focal seizures, trigeminal neuralgia
cabamazapine AE
SIADH, DRESS syndrome, agranulocytosis
carbamazapine CYP450
strong inducer
phenytoin spectrum
tonic-clonic seizures, status epilepticus
phenytoin AE
gingival hyperplasia, hirsutism, nystagmus, drug induced lupus, teratogenic
phenytoin CYP450
strong inducer
levitiracetam spectrum
first line for focal seizures
what is a complication of IIH
blindness
where is wernickes area
dominant temporal lobe (almost always left)
what blood vessel supplies wernickes area
middle cerebral artery
when can patients go back to activity post concussion
2 days rest followed by gradual increase in activity level
will deep tendon reflexes still be present in brain death
yes! because this does not involve the brain
what neurons die in huntingtons
GABA neurons so this is why you have spasticity
how do you treat someone in an acute myasthenic crisis
IVIG
what are the hallucinations typically like when parkinsons patients have them
typically visual hallucinations - animals playing in the front yard, and they know they arent real
can aspergillus cause meningtitus
no! typically causes a focal mass
how do you tell the difference between central and peripheral nystagmus
central often is not fatiguable and there is no latency period, its not inhibited by fixation of gaze
what does central vertigo indicate
likely a stroke in the cerebellum or brainstem
what can you give MS patients for spasticity
baclofen or tizanidine
