1 Flashcards
(105 cards)
0
Q
Causes of limbic lesions
A
(ie memory, emotion, behavior, olfaction, motivation)
- Herpes encephalitis
- Paraneoplastic syndroms:
- -Anti ma2 in testicular cancer
- -anti NMDAR ovarian cancer like teratoma
- -anti-hu small cell carcinoma
1
Q
Argyll-Robertson pupils
A
Pupils in neurosyphilis that react to accommodation but not to direct light
2
Q
Postperfusion syndrome symptoms
A
Post surgical problems with attention, concentration, short term memory, fine motor function, speed of mental and motor responses
3
Q
Sx of concussive disorder
A
Sleep disturbance, mood change, poor concentration and memory, lightheadedness, nausea
4
Q
pseudotumor cerebri (=IIH) dx
A
Normal MRI or slit like ventricles, diagnose with LP
5
Q
tx for trigeminal neuralgia?
A
Carbamazepine
6
Q
Intra axial lesion that enhances heterogeneously?
A
Glioblastoma
7
Q
Extra axial lesion that enhacnes uniformly and is hyperdense on unenhanced CT?
A
Meningioma
8
Q
what is the sella?
A
sits around pituitary
9
Q
What do you do for tx of Menieres?
A
Labyrinth ablation and gentamicin
10
Q
CSF findings in GBS
A
albuminocytologic dissociation, which is an elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells
11
Q
what CN can ICP involve?
A
6
12
Q
Saccule
A
Linear and head tilts in vertical plane of head (in the inner ear)
13
Q
Utricle
A
Horizontal plane linear movements and head tilts in the inner ear
14
Q
Lateral/horizontal semicirc canal
A
Head turn L and R
15
Q
Superior semicirc canal (anterior)
A
Head nod
16
Q
Posterior semicirc canal
A
Head to shoulders
17
Q
Type of nystagmus in BPPV
A
with dix hallpike maneuver produces mixed vertical torsionalvector nystagmus with fast phase beating upward and toward the affected hear
18
Q
What part of the brain does this involve? Gaze evoked and persistent downbeat nystagmus
A
Central lesion involving cerebellum
19
Q
Somatization Disorder
A
somatic complaints without a medical explanation
20
Q
Oxcarbazepine (how it works, what its for, side effects)
A
Na channel
Partial seizure
Hyponatremia and sedation
21
Q
Phenytoin (how it works, what its for, side effects)
A
NA channel
Partial seizure
Gingival hyperplasia, ataxia, coarse facial features
22
Q
VAlproic acid (how it works, what its for, side effects)
A
Na channel, GABA
Partial and general
GI sx, NT defects, thrombocytopenia, wt gain, hair loss, accelerated loss of bone density
23
Q
Phenobarbital (how it works, what its for, side effects)
A
GABA
Partial, gen
Sedation
24
Ethosuximide (zarontin) (how it works, what its for, side effects)
T type Ca channel
Ansemce
GI sx
25
Gabapentin (how it works, what its for, side effects)
Partial
| Sedation, ataxia
26
LAmotrigine (Lamictal) (how it works, what its for, side effects)
Na channel, glutamate receptor
Partial, gen
SJS, rash
27
Topiramate (how it works, what its for, side effects)
Na channel, GABA
Partial, gen
Word-finding difficulty, renal stones, wt loss
28
Tiagabine (how it works, what its for, side effects)
GABA reuptake
Partial
Sedation
29
Levetiracetam (keppra) (how it works, what its for, side effects)
Partial, gen
| Insomnia, anxiety, irritability
30
Zonisamide (how it works, what its for, side effects)
Partial, gen
| Sedation, renal stones, wt loss
31
Which anti-epileptic drugs are P450 inducers?
Phenobarbitol, Phenytoin, carbamazepam
32
Carbamazepine (how it works, what its for, side effects)
Na channel
Partial
Hyponatremia, agranulocytosis, diplopia
33
Which anti-epileptic drugs are P450 inhibitors?
Valproic acid
34
Drugs that cause Parkinson's-like movements
Anti-psych (akathisia)
Metoclopramide (reglan)
Valproate
Amphotericin B
35
Tx for when drugs cause parkinson like movements?
IV dephenhydramine (benadryl)
36
Which chemo drugs cause peripheral neuropathies?
docetaxel, paclitaxel, vincristine, platinum
37
Which chemo drugs cause cerebellar ataxia?
cytosine arabinoside or 5-fluorouracil
38
What is RPLS?
reversible posterior leukoencephalopathy syndrome (RPLS): due to HTN/preeclampsia and immunosupp drugs etc leading to HA, confusion, seizures, visual loss (occip lobe lesion)
Vascular injury with loss of autoregulation, hypertension, vasospasms, seizures, confusion and MRI/CT pic of posterior leukoencephalopathy leads to diagnosis
39
What drugs cause reversible posterior leukoencephalopathy syndrome (RPLS)
lots of chemo drugs and cyclosporine and tacrolimius (ie immunosupp)
40
Steroids cause what psychiatric problem
Steroid psychotic rxn
| -agitation, sleep disturbance, paranoia leading to possible neuroleptic therapy
41
Carbamazepine (or other anti-epileptics) and azithromycin drug interaction
Causes ataxia, nystagmus and diplopia at higher levels
42
What drugs can aggravate hyponatremia caused by oxcarbazepine or carbamazepine?
taking HCTZ or levetiracetam (keppra)
43
Anti-cholinergic OD causes what?
Tachycardia, blurred vision, fever, MS change and urinary retention (in elderly only).
44
What kind of drug do anticholinergics counteract?
Neuroleptics
45
Benzo withdrawal causes what sx
Agitation, tachycardia, serotonin syndrome
46
What are you at risk for with migraines and depression?
SSRIs plus triptans cause serotonin syndrome
47
Neuroleptic malignant syndrome
dd
48
Periodic lateralizing discharges
EEG abnormality commonly seen in herpes encephalitis, focal brain lesions, nonketotic hyperglycemia, alcohol withdrawal, theophylline exposure
49
Generalized periodic discharges
EEG abn seen in anoxic brain injury, CJD
50
Stimulus-induced, rhythmic, periodic or ictal discharges
EEG abn: SIRPIDs/ictal discharges are most commonly seen in critically ill patients, even without neurologic illness
51
Burst suppression
EEG abn commonly seen in anoxic encephalopathy or in the s/o meds like propofol or barbiturates
52
If you have a bad reaction to phenytoin, what other anti-epileptics should you avoid?
carbamazepine and primidone --->these can also interact with warfarin
53
What is juvenile myoclonic epilepsy?
Kids 12-18 get brief muscle twitch in the am. Ion channel issue
54
Tx for juvenile myoclonic epilepsy
Levetiracetam
| Valproic acid works too, but risk teratogenicity and PCOS in adolescent women
55
Fetal exposure to which anti-epileptic is associated with lower IQ
Valproic acid
56
Which anti-epileptic is associated with challenges in word finding?
Topiramate
57
First line in status epilepticus ? Then what?
Use IV lorazepam then IV phenytoin/fosphenytoin if it continues, then intubate and give phenobarbital then induce coma with barbiturates, midazolam or propofol with continuous bedside EEG monitoring
58
Pituitary apoplexy
Acute dec in blood to pituitary often after childbirth (Sheehan's syndrome) that p/w HA, visual sx and adrenal insufficiency
59
Common eye issue caused by steroids?
Cataracts (cloudy lens, pt can't see out and you can't see in)
60
Amblyopia ex anopia
"Lazy eye" due to disuse. Patients won't have stereoscopic vision ie depth perception
61
Causes of INO in younger vs older people
Young: demyelination
Old: paramedian pontine perforating vessel stroke
62
Optic neuritis sx
Pain on eye movement with central scotoma (ie macular defect)
63
Papilledema sx
Abn fundus with enlarged blindspot (ie centrocecal scotoma-->macular defect including the blind spot)
64
Temporal arteritis is associated with which disease?
Polymyalgia rheumatica (pain in hips and shoulders due to giant cell arteritis)
65
If a patient has a posterior communicating aneurysm clipped with deterioration 3d later, what happened and how do you treat?
Vasospasm, tx with nimodipine
66
sx of posterior communicating aneurysm rupture?
3rd n palsy with pupillary involvement
67
Monoccular vision loss that can be improved by patient looking through a pinhole localizes where?
Monocular visual loss=lesion ant to optic chiasm (ie eye itself or optic nerve). If acuity is improved thorough the pinhole, problem is refractive or ocular, and not neurological
68
Causes of ischemic optic neuropathies?
Surgery (prolonged anesthesia compressing artery, usually posterior), drugs like amiodarone, INF alpha, nasal decongestants, phosphodiesterase inhibitors, and systemic blood loss
-->if you have giant cell arteritis, tx is emergency steroids get esr
ION pw painless vision loss over hours to days ages 57-65. Blurred vision and altitudinal field defects
risk factors are HTN, diabetes, congenitally small optic cup
69
Who does cryptococcal meningitis occur in?
Immunocomp, often HIV CD4 <100
70
Consequences of cyrpotcoccal meningitis?
visual loss directly to optic n or due to icp
71
Treatment for cryptococcal meningitis?
```
Triple therapy
1. Amphotericin
2. 5-Flucytosine
3.Fluconazole
or lifelong intraconazole ppx
```
72
How do you treat multiple enhancing brain lesions in an HIV pt?
Likely abscesses, tx with pyrimethamine/sulfadiazine and folic acid
73
ppx for bacterial meningitis?
Cipro or rifampin PO 2 days (serogroup B not covered by vaccine)
74
HSV encephalopathy has what CSF BC components?
Red and white
75
What distinguishes crypto meningitis from others in the CSF?
Very high opening pressure
tx with ampho B and flucytosine
76
Signs of TB meningitis?
Very low glucose in CSF, basilar meningitis, cranial neuropathies, inc ICP, hydrocephalus
77
Most common cause of acquired epilepsy in areas like the DR?
Neurocysticercosis (t. solium)=tapeworm. Diagnose with enzyme-linked immunoelectrotransfer blot (EITB) assay. High rates of false negative with only one CNS lesion
78
Albendozole
For tapeworm tx
79
Pt presents with peripheral 7th nerve palsy/Bell's palsy in the winter in chicago?
Since it's not in the NJ summer, it's not lyme. This is HSV
80
How is HSV enceph treated?
Prednisone if the patient is seen within the first 48 hours and then add antivirals
81
IV acyclovir is toxic to which organ?
Nephrotoxic causing acute tubular necrosis
| -->slow infusion and patient hydration reduce risk
82
HSV2 reactivation
Can lead to meningitis and genital herpes. Get recurrent radicular pain, saddle anesthesia and urinary retention
=most common cause of recurrent meningitis
83
How long after surgery is meningitis infection most likely?
Most common within the first month but can occur even months or years postoperatively. CSF pleocytosis without bacterial growth is seen after posterior fossa surgery
84
What is posterior fossa syndrome?
j
85
Lyme disease manifestations in children
bilateral peripheral VII nerve palsies
86
Congenital CMV sx
Hearing loss, spacticity, hyperintensities along ventricular margins on MRI
87
Raw honey fed to a newborn puts them at risk for?
Tetanus
89
Enterovirus D 68 causes what?
Paralytic disease
90
AE drug that can be used to treat myoclonus
Levetiracetam (keppra)
91
What is lance adams?
postanoxic myoclonus (exacerbated by movement), like after CPR
92
What AEs treat lance adams?
Valproate, clonazepam, levitracetam
93
What AEs treat lance adams?
Valproate, clonazepam, levitracetam
94
Nutritional def or OD with afferent ataxia?
Vit E, B12, Cupper, or intoxication with pyridoxine
95
Nutritional def or OD with afferent ataxia?
Vit E, B12, Cupper, or intoxication with pyridoxine
96
What is resperidone?
Dopamine antagonist
97
Sid eeffects of dopamin antagnoists including typical and atypical antipsychotics?
Tardive dystonia (involuntary repetitive movements from antipsychotics)
98
Sid eeffects of dopamin antagnoists including typical and atypical antipsychotics?
Tardive dystonia (involuntary repetitive movements from antipsychotics)
99
Trihexyphenidyl
used for parkinson tumor
100
1st line for essentail tremor for someone with diabetes/asthma?
Primidone
101
1st line for essentail tremor for someone with diabetes/asthma?
Primidone
102
tx for trigeminal neuralgia?
carbemazepine
103
What is donepezil?
ACHE inhibitor for alz
104
What is donepezil?
ACHE inhibitor for alz
105
What is bevacizumab?
VEGF inhibitor
