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mi harrissons > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the risk of stroke in the first 3 months following a transient ischemic attack?

A

10-15%,with most events occurring in the first 2 days

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2
Q

Most common site for hypertensive hemorrhage is

A

PUTAMEN

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3
Q

Gold standard for evaluating the precise anatomy of the AVM

A

Conventional X-ray angiography

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4
Q

Largest lesion of avm is located at

A

POSTERIOR HALF OF HEMISPHERE

(Wedge shaped lesion extending to the ventricles),

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5
Q

Angiograpgic features of AVM that predicts higher bleeding risks

A

Smaller lesionS
Deep vein drainage
Vein outflow stenosis
Intranidal aneurysm

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6
Q

Results from multiple small vessel infarcts within the subcortical white matter likely from chronic hypertension and may lead to subcortical dementia syndrome

A

Leukoaraiosis

Aka periventricular white matter disease

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7
Q

The most common cause of viral meningitis

A

ENTEROVIRUS

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8
Q

What is the recommended chemrophylaxis for individuals exposed to meningococcal meningitis?

A

RIFAMPIN 600mg q12 for

2 days

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9
Q

What is the antibiotic of choice for meningococcal meningitis for susceptible strains?

A

PENICILLIN G

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10
Q

What is the antibiotic of choice for meningococcal meningitis with CSF ISOLATES N. Meningitidis that is resistant to penicillin and ampicillin ?

A

CEFOTAXIME
OR
CEFTRIAXONE

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11
Q

What is the ALTERNATIVE chemrophylaxis for individuals exposed to meningococcal meningitis?

A

Azithromycin

Ceftriaxone

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12
Q

Px with HIV and meningitis symptoms and CSF abnormalities.
India ink staining of CSF: (+)FUNGI
Diagnosis?
WHAT IS THE TREATMENT?

A

Diagnosis: CRYPTOCOCCAL MENINGITIS

TX
Amphotericin B + FLUCYTOSINE X al least 2 weeks
Followed by FLUCONAZOLE X at least 8weeks

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13
Q

a patient suspected of HERPES SIMPLEX VIRUS encephalitis but with CSF PCR analysis that is negative. What is the next course of action?

A

Continue Acyclovir and REPEAT LUMBAR PUNCTURE

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14
Q

What is the standard criterion for treatment success in syphilitic meningitis?

A

NORMAL CSF count within 12 months and
decrease in VDRL titer by TWO dilutions or
REVERT to NON REACTIVE within 2 years of complete therapy

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15
Q

What condition presents with recurrent meningoencephalitis with uveitis, retinal detachment, alopecia, lightening or eyebrows and lashes, cataracts and glaucoma

A

VHK

VOGT KOYANAGI HARADA SYNDROME

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16
Q

What virus causes tropical spastic paraparesis

A

Human T cell lymphocytic virus 1

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17
Q

What is the management for status epilepticus

A

Anticonvulsant: Give IV BENZODIAZEPINE
(Lorazepam, midazolam,clonazepam)
followed by antiepileptic drugs: Levetiracetam 20mg/kg
(Phenytoin, valproate acid)

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18
Q

Most common syndrome associated with focal seizures with impairment of consciousness and has distinctive clinical, EEG and pathological feature

A

Mesial temporal lobe epilepsy syndrome

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19
Q

Highly selective loss of specific cell populations within hippocampus in most cases

A

Mesial temporal lobe epilepsy syndrome

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20
Q

Most common seizure type resulting from metabolic derangement

A

Generalized tonic clinic seizure

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21
Q

First line antiepileptic drug for focal seizure that acts in the modulation of the release of synaptic vesicles

A

levetiracetam

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22
Q

When cerebral blood flow remains poor for a longer duration leading to infarction in the border zones between the major cerebral artery distributions with WIDESPREAD BRAIN NECROSIS

A

Global hypoxia Ischemia

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23
Q

Resulting cognitive sequele to Global hypoxia Ischemia

A

HIE

HYPOXIC ISCHEMIC ENCEPHALOPATHY

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24
Q

Magnitude of flow reduction is a a function of collateral blood flow:
Bloodflow of zero

A

Brain tissue death within 4-10mins

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25
Q

Magnitude of flow reduction is a a function of collateral blood flow:
Bloodflow of <16-18ml/100g tissue/min

A

INFARCTION WITHIN AN HOUR

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26
Q

Magnitude of flow reduction is a a function of collateral blood flow:
Bloodflow of <20ml/100g tissue/min

A

Ischemia without infarction

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27
Q

Medical support in stroke: maintain glucose of

A

60-180mg/dL using an insulin infusion

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28
Q

Peak of cerebral edema

A

2nd to 3rd day and can last for 10days

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29
Q

Management of cerebral edema

A
  1. Water restriction, IV mannitol
  2. Avoid hypovolemia
  3. Hemicraniectomy
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30
Q

What is the prophylactic surgery for prevention of brainstem compression

A

SUBOCCIPITAL DECOMPRESSION OF LARGE CEREBELLAR INFARCTS

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31
Q

The only antiplatelet agent proven safe and effective for the acute treatment of ischemic stroke

A

Aspirin

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32
Q

Most common site of infarction via cardioembolism

A

Intracranial internal carotid artery ICA
MCA middle cerebral artery
PCA posterior cerebral artery

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33
Q

Most common cause of cardioembolic stroke

A

NONVALVULAR OF NONRHEUMATIC AF

Annual average is 5%

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34
Q

Most common source of artery to artery embolus

A

CAROTID BIFURCATION

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35
Q

Most frequent site in the carotid for artery to artery embolism stroke

A

Common carotid bifurcation

Proximal internal carotid artery PICA

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36
Q

Location of infarction in a patient who

Presents with PURE MOTOR HEMIPARESIS ONLY

A

Posterior limb of internal capsule
Or
PONS

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37
Q

Location of infarction in a patient who

Presents with PURE SENSORY ONLY

A

Ventral THALAMUS

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38
Q

Location of infarction in a patient who

Presents with ATAXIC HEMIPARESIS ONLY

A

VENTRAL PONS
OR
INTERNAL CAPSULE

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39
Q

Location of infarction in a patient who

Presents with DYSARTHRIA AND CLUMSY HANDS OR ARMS ONLY

A

Ventral pons

Genu of internal capsule

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40
Q

Cause of stroke that affects cervical arteries mainly in women, presence of multiple rings or segmental narrowing alternating with dilation in carotid or vertebral arteries.

A

FIBROMUSCULAR DYSPLASIA

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41
Q

Most significant risk factor in stroke and TIA

A

Hypertension
BP goal <140-150/90
(Recommendation of vascular neuro <130/80)
Elderly: lower SPP

DRUGS: ACEI AND THIAZIDES DIURETIC

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42
Q

What DM drug lowers risk of recurrent stroke, MI and vascular death

A

PIOGLITAZONE

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43
Q

Anticoagulation goal INR in chronic NONVALVULAR AF that prevents cerebral embolism and is safe

A

INR 2-3

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44
Q

For primary prevention or for patients who have experienced stroke or TIA, what drugs reduces the risk by about 67%

A

Vitamin k antagonist (warfarin,dicumarol)

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45
Q

Oral thrombin inhibitor that is non-inferior to VKA in preventing second stroke or systemic embolization

A

DABIGATRAN

46
Q

Higher dose of dabigatran that makes it superior to VKA

A

150mg/d

47
Q

Lower dose of dabigatran that makes it have lower rate of major bleeding compared to VKA

A

110mg/d

48
Q

Oral Factor Xa inhibitor that is non-inferior and EVEN SUPERIOR to VKA, with LOWER RISK of bleeding

A

APIXABAN

49
Q

Oral anti-Xa anticoagulants that are non inferior to VKA

A

Rivaroxaban and ENDOXABAN

50
Q

anticoagulant therapy for untreated rheumatic heart disease

A

Long term warfarin (untreated RHD)

51
Q

3 month anticoagulation course in Acute MI REDUCES risk of embolism in:

A

Acute myocardial infarction with:

Anterior q wave infarction
Substantial LV dysfunction 
CHF
MURAL THROMBOSIS
AF
52
Q

Most serious complication of prosthetic heart valve implantation

A

STROKE sec to thromboembolism

53
Q

True or false

AVOID ANTITHROMBOTIC AGENTS FOT INFECTIVE ENDOCARDITIS

A

True

May cause pericardial hemorrhage

54
Q

What is the recommended antithrombotics for non bacterial thrombotic endocarditis

A

Full dose unfractionated HEPARIN or SC LMWH

55
Q

MCA forms collateral formation via

A

LEPTOMENINGEAL VESSELS

56
Q

Parts supplied by the lenticulostriate arteries from the proximal MCA

A

Outer Globus pallidus
Posterior limb of internal capsule
Adjacent corona radiata
Caudate nucleus

57
Q

Manifestation of MCA syndrome

A 
Contralateral hemiplegia
Hemianesthesia
Homonymous hemianopia 
Ipsilateral preferential gaze (1-2 days)
Dysarthria due to facial weakness
58
Q

Manifestation of MCA syndrome with dominant hemisphere involved

A

GLOBAL APHASIA

59
Q

Manifestation of MCA syndrome with non-dominant hemisphere involved

A

ANOSOGNOSIA
CONSTRUCTIONAL APRAXIA
NEGLECT

60
Q

Anti-epileptic drug that modulates release of synaptic vesicles

A

Levetiracetam

Brivaracetam

61
Q

Antiepileptic drug that inhibits T type ca channels in the thalamus neurons

A

ETHOSUXIMIDE

VALPROIC ACID

62
Q

HLA allele that caries high risk for developing serious skin reaction from carbamazepine, phenytoin, oxcabazepine and lamotrigine

A

HLA B 1502

63
Q

HLA Allele that is associated with carbamazepine induced hypersensitivity reaction in patients of European or Japanese ancestry

A

HLA A 31:01

64
Q

Patient profile with the greatest chance of remaining seizure free after drug withdrawal

A
  1. Complete medical control of seizures for 1-5 years
  2. Single seizure type, with generalized seizures having a better prognosis than focal seizures
  3. Normal neuro examination including intelligence
  4. No family history of epilepsy
  5. Normal EEG
65
Q

After reasonable attempt to withdraw antiepileptic drugs after 2 years, most recurrences occurs when?

A

First 3 months

66
Q

Marked increase in seizure frequency around the time of menses

A

CATAMENIAL EPILEPSY

67
Q

Pregnant women should take how many mg of folate

A

1-4mg/day

68
Q

What is the most common primary headache syndrome

A

Tension type headache

69
Q

Prophylaxis or Preventive treatment for headache

A

TOPIRAMATE
PROPANOLOL
AMITRIPTYLINE
VALPROATE

70
Q

What is the mechanism of action of sumatriptan

A

5HT 1B/1D RECEPTOR AGONIST

71
Q

What is the only proven treatment for CHRONIC tension type headache

A

AMITRIPTYLINE

72
Q

Drugs that can be used to treat acute tension type headache

A

Acetaminophen
Aspirin
NSAIDS

73
Q

True or false

TRIPTANS can only be effective in MIXED TTH with +MIGRAINE

A

True

74
Q

Best treatment option for cluster headache

A

100% oxygen at 10-12L for 15-20mins

75
Q

What is the treatment of choice for a Unilateral, severe short lasting episodes of headache, with very frequency attacks (5-40x per day) , has a rapid course and a marked autonomic features ipsilateral to the pain

A

Diagnosis: PAROXYSMAL HEMACRANIA

TOC: Indomethacin

76
Q

Presents with EXCRUCIATING PAROXYSMS of lancinating pain involving her right cheek and jaw. (Lancinating : it give u fever or flu sa kasaki)
Speaking, chewing or brushing her teeth can trigger an attack. After pain occurs there is a period of time where she can speak, eat or brush without pain hence paroxysm.

A

TRIGEMINAL NEURALGIA

77
Q

What is the most important risk factor for Alzheimer’s disease

A

Age > 70 years and a POSITIVE family history

78
Q

Risk factors for Alzheimer’s disease:

A

Diabetes
History of head trauma with concussion
Women who carries a single APO E4 allele

79
Q

There widespread neurotic PLAQUES, neurofibrillary tangles [NFTs] and AB accumulation in blood vessels wall In the Cortex And Leptomeninges

A

Alzheimer’s disease

80
Q

Medication for Alzheimer’s that is no longer used due to hepatoxicity

A

TACRINE

81
Q

Medications used for Alzheimer’s

A

DONEZEPIL
RIVASTIGMINE
Galantamine
Memantine

82
Q

Most common source of brain metastases

A

Lung and breath CA

83
Q

What malignancy has the greatest propensity to metastasize to the brain

A

MELANOMA (same embryonic source)

84
Q

malignancies that will cause hemorrhagic metastases to the brain 🧠

A

Renal cell ca
Choriocarcinoma
Melanoma
Papillary thyroid carcinoma

85
Q

Which brain malignancy is characterized by Codeletion of 1p/19q and usually have IDH mutation

A

Oligodendroglioma

86
Q

What virus plays an important role in the pathogenesis of primary CNS lymphoma

A

Epstein Barr virus

87
Q

In a patient who presents with facial paralysis of wrinkle his forehand or close his eye) , (+)pain behind ear may precede the paralysis for a day or two, (+)decrease taste (+)hyperacusis

A

Bell’s palsy - MCC of facial paralysis

Normal NE except for facial nerve

88
Q

Best treatment for Bell’s palsy

A

Prednisone 60-80mg daily during the first 5 days then tapered over the next 5days

89
Q

True or false

Antiviral agents (acyclovir or valacyclovir) combination with glucocorticoid maybe marginally better than prednisone alone in severe Bell’s palsy

A

True

90
Q

What is the most favorable prognostic sign in Bell’s palsy

A

Presence of Incomplete paralysis in the first week

91
Q

In Bell’s palsy, evidence of denervation after 10days on EMG indicates

A

AXONAL degeneration

92
Q

In a patient recurrent episodes of vertigo lasting for 30 minutes associated with TINNITUS and a feeling of fullness in his right ear. + Decreased hearing in the right ear.
Normal MRI and neurological exam . What should be the procedure done?

A

Ménière’s disease

Procedure : audiometry

93
Q

Patient complains of vertigo lasting for 30mins with movement lasting for 3 weeks, with relief when he lies down. NO HEARING LOSS and with normal NE. (-) DIX HALLPIKE MANEUVER
DIAGNOSIS AND TX?

A

BPPV

TX: CANALITH repositioning procedure

94
Q

True or false:

A negative DIX HALLPIKE maneuver does not rule out BPPV

A

True

95
Q

What is the most common Antibody target for miller fisher syndrome

A

Anti-Gq1b IgG found in >90%

96
Q

May have an acute onset that Mimics GBS but symptoms deteriorate after 9 weeks and relapses at least 3x

A

Chronic inflammatory demyelination polyneuropathy

CIPD

97
Q

What is the gold standard for the diagnosis of small fiber neuropathy

A

Skin biopsy

98
Q

Systemic malignancy that commonly associated with subacute sensory neuropathy due to antibodies and cytotoxic T cells that cross react with the HU proteins of the dorsal root ganglion neurons resulting in immune mediated neuronal destruction

A

Small cell LUNG cancer

99
Q

May present with visual symptoms that are generally monocular and are preceded by periorbital pain aggravated by eye movements

A

Multiple sclerosis

100
Q

Chronic use of natalizumab for chronic Multiple sclerosis may cause infection by the John Cunningham virus seen on CSF by PCR

A

Progressive multi focal leukoencephalopathy

101
Q

Is an oral sphingosine - 1 phosphate inhibitor that reduces the attack rate and improves all measures of disease severity in multiple sclerosis thru the sequestration of lymphocytes in The periphery thus inhibiting their trafficking to the CNS

A

FINGOLIMOD (oral) -S1P inhibitor 0.5mg PO OD

102
Q

Disease modifying therapies for relapsing MS

A
  1. FINGOLIMOD
  2. Dimethyl fumarate
  3. teriflunomide
103
Q

Disease modifying therapies for relapsing MS which is a Krediet cycle metabolite with anti-inflammatory effects

Inhibits the ubiquitylation and degradation of nuclear factor E2 related factor

A

Dimethyl fumarate

104
Q

Disease modifying therapies for relapsing MS which is a dihydro-orotate dehydrogenase inhibitor, exerts anti inflammatory effects by limiting the proliferation of rapidly dividing T and B cells (CYTOSTATIC)

A

TERIFLUNOMIDE

105
Q

Variant of MultiPle sclerosis may present acutely as solitary lesion, often mistaken as brain tumor, and follows a fulminant course typically with no remissions

A

Marburg’s variant

106
Q

Diagnostic procedure for myasthenia gravis

A

(+) anti-Achr radioimmunoassay

Acetylcholine

107
Q

Negative anti-achr radioimmunoassay does not rule out myasthenia gravis and 40% will have positive

A

Anti-Musk antibodies

108
Q

A zero positive MG px was admitted at ICU with respiratory failure, severe weakness and dysphasia. What is the best treatment option:

A

A course Of 5 five plasma exchanges over a 10 days period

109
Q

Steroid therapy for myasthenia crisis

A

Start high dose prednisone 60mg/day given in a single dose

110
Q

Ina patient diagnosed with MG taking “pyridostigmine 180 mg q hours” complains of excessive drooling, diarrhea, slurring Of speech and worsening of weakness. What is the common side effect?

A

Acetylcholine inhibitor overdose

Patient shows cholinergic symptoms

111
Q

What is the most common sign/symptom accompanying severe migraine attacks?

A

Nausea

112
Q

52/F, presents with a unilateral, throbbing frontal headache of moderate in intensity and aggravated by movement, associated with nausea and vomiting. The headache is being felt repeatedly and lasting for almost the entire day. PE: normal. What is the most likely diagnosis?

A

Migraine

mi harrissons (62 decks)

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