16 Random Flashcards by Mina Butterfly

Tics treatment

Clonidine, atypical antipsychotics

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Superficial siderosis

Iron deposition by chronic bleeding SAH or subdural, Sensorineural hearing loss, anosmia, anisocoria, ataxia, dementia, UMN, 1,3,4,5

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Flying:
Pneumothorax:
Pregnancy:
ablation:
PCI:
MI uncomplicated/ CVA:
CABG:
MI complicated:
Heart transplant:
ICD: prophylactic , Vtac

Pneumothorax: 1 week post cxr
Pregnancy: 36w ( 32 if multiple pregnancy )
ablation: 2days
PCI: 3 day-1 week Lorry: wait 6 week, then do exercise treadmill test
MI uncomplicated/ CVA: 1 week
CABG: 2-4 week
MI complicated: 1 month
Heart transplant: 6 weeks
ICD: prophylactic 1 month, Vtac 6month

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DLVA ( driving )
1 explained treated syncope:
1 unexplained syncope/First seizure/withdrawal epilepsy medication:
Epilepsy/2 syncope:
5 year seizure free:
TIA/CVA with no residual:
Multiple TIA:
Pituitary tumor, Post trans sphenoidal surgery:
Craniotomy for meningioma: 1year, if it was initially seizure free:
Narcolepsy/cataplexy:
Diabetes:

DLVA ( driving )
1 explained treated syncope: 1 month
1 unexplained syncope/First seizure/withdrawal epilepsy medication: 6 month
Epilepsy/2 syncope: 1year, seizure free
5 year seizure free: Normal license until 70
TIA/CVA with no residual: 1 month
Multiple TIA: 3 month
Pituitary tumor, Post trans sphenoidal surgery: 6 month
Craniotomy for meningioma: 1year, if it was initially seizure free: 6 month
Narcolepsy/cataplexy: Cease on diagnosis, can restart once satisfactory control
Diabetes: No hypoglycemic attack for the past year

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Brain herniation

Sub falcine/cingulate: Anterior cerebral artery
Transtentorial: Rupture basilar, duret hemorrhage
Uncal: Ipsilateral 3, homonymous hemianopia macular sparing (PCA), contralateral paresis

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Anti NMDA receptor encephalitis

Paraneoplastic syndrome, ovarian teratoma, african caribbean, psychotic ( hallucination, delusion, disordered thinking, insomnia ) dyskinesia, autonom, seizure , bi directional nystagmus, intention tremor, dysdiadokinesia, broad based gait Treat with IV corton, IVIG, plasmapheresis, rituximab, cyclophosphamide, removal teratoma
ANTI NMDA drug: Ketamin, third line neuropathic pain manage

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Acute sinusitis

Inflammation mucus membrane paranasal sinus, double sickening ( initial viral turns into secondary bacterial infection )
Streptococcus pneumoniae, Haemophilus influenzae, Rhinovirus
Facial pain, frontal pressure pain worse on leaning forward, thick purulent nasal discharge and obstruction
Analgesic, Decongestants, nasal saline
Severe/ more than 10 days: Phenoxy methyl penicillin, Intranasal corton

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Hemiballistic:
Chorea:
Ataxia:
Tremor:
Parkinsonism:
Wernicke/korsakoff:
Kluver bucy(hyper sexuality, hyper orality, hyper phagia, visual agnosia):

Hemiballistic: Subthalamic nucleus Treat: dopamine antagonist ( like metoclopramide)
Chorea: Caudate/striatum Basal ganglia
Ataxia: Dentate
Tremor: Red nucleus
Parkinsonism: Substantia nigra basal ganglia
Wernicke/korsakoff: Mammillary body hypothalamus, medial thalamus
Kluver bucy(hyper sexuality, hyper orality, hyper phagia, visual agnosia): Amygdala

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Cervical dystonia

Episodic torticollis, involuntary neck movements, Treat with Botulinum injection

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Paraneoplastic cerebellar syndrome

Breast ovary, small cell, ataxia vertigo oscillopsia dysarthria, NL MRI, Anti purkinje CSF, anti-YO, anti HU, treat with corton, IVIG Plasmapheresis
DD: alcoholic cerebellar degeneration, spinocerebellar ataxia, MS, Infective, CJD

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POEMS

Paraneoplastic by plasma cells, polyneuropathy, organomegaly, endocrinopathy, M protein band, hyper pigmentation, osteoblastic lesion spine

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Wernicke/Korsakoff:

horizontal nystagmus (most common sign), conjugate gaze palsy, bilateral 6th nerve palsy, INO
ataxia, Confusion, memory impairment, confabulation, hallucination, seizure, decreased red cell transketolase
Prolonged thiamine deficiency can make wernicke turn into permanent memory damage Korsakoff -> retrograde/anterograde amnesia (unable to form new memories), confabulation, telescoping of memory ( thinks distant memories happened recently )
*confabulation also seen in alzheimer.
Treatment: Thiamine TID 5 days, then QD 5 days
Causes: Alcohol, malnutrition, dialysis, HIV

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Pabrinex: B complex cocktail

Delirium tremens: tactile/auditory/visual/lilliputian hallucination

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Willson

Autosomal recessive, Kayser feischer (Descemet membrane) , tremor, dysarthria ataxia and clumsiness,parkinsonism (tremor, rigidity, dystonia, chorea)
Diagnosis: High urinary copper, low ceruloplasmin/copper/urate
Treatment: Penicillamine, trientine, zinc acetate

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Neurofibromatosis

Neurofibromatosis 1: 7 Cafe o lait, axillary/inguinal freckle, lisch node (dome shaped, gold brown)
Neurofibromatosis 2: Bilateral vestibular schwannoma, Bilateral cataracts

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Holmes adie VS argyll Robertson?

Holmes Adie: One Big,very slow/no light, slow accommodate, associated with AREFLEXIA, benign condition, hypersensitivity pilocarpine
Argyll Robertson: bilateral small irregular, no answer to light, normal accommodate, light-near dissociation, DM, alcohol, MS, neuroSyphilis ( Prostitutes’ pupil), Lyme, Viral encephalitis

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Aphasia

Wernicke/Receptive: Superior temporal gyrus, Inferior Left MCA
Fluent speech that makes no sense, word salad
Broca/Expressive: Inferior frontal gyrus,pre central area, Superior Left MCA
Labored speech, impaired repetition
Conduction: Arcuate fasciculus/presylvian, Normal comprehension, Fluent speech, poor repetition, aware of their restless errors
Global aphasia: all 3 areas,Pre sylvian + thalamus, may still communicate with gestures

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Restless leg syndrome

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wakes patient up at night,
Trigger: deficiency iron/ folate/ magnesium, amyloidosis, DM, pregnancy, uremia, SSRI, SNRI, diphenhydramine
Treatment: iron, Pramipexole, rotigotine, ropinirole, Gabapentin, pregabalin (check GFR beforehand) , bromocriptine, carbidopa, levodopa

Tourette syndrome

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Vocal/motor tics, coprolalia (swearing), echolalia, palilalia, supressable to some degree, ADHD OCD self mutilation, Psychoeducation, habit reversal therapy, exposure with response -> CBT -> Clonidine, guanfacine -> Risperidone, aripiprazole

Diffuse axonal injury

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result of deceleration

Extradural

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Usually Middle meningeal artery rupture caused by temporal fracture,

Lucid interval (better prognosis)

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Extradural/epidural hemorrhages, subdural! artery bleedings

Subdural hemorrhages

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Neurological symptoms may take weeks to develop, alcoholism head trauma, ld age, anti coagulation, it might be minor and patient even forgets about it, single Lucid interval, cortical bridging venous bleeding, usually frontal, parietal , Observe if no FND

Subarachnoid hemorrhage/SAH

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Most common trauma (ACA), then spontaneous berry rupture (HTN, ADPKD, Ehler danlos, coarctation aorta) pituitary apoplexy
Thunderclap headache, meningism (occipital pain on neck flexion or SLR, neck stiffness) , FH +, ST elevation! CT (blood in cisterns and sulci) sensitive 6h of headache onset (blood in cisterns), LP 12 h after onset (not sooner), after that xanthochromia detectable with spectrophotometry, if its too late, centrifuged to take out RBCs produced cause of LP needle
Treatment: First Labetalol (target BP 14, MAP 11), nimodipine, if suspected for aneurysm: CT angiogram, then endovascular Coil within 24h
Complication: Hydrocephalus ( Drowsiness, Bilateral papilledema and 6th nerve palsy) , repeat CT, temporary external drain
Re-bleeding: 10% within 12h
Vasospasm: 1-2 weeks , SIADH, seizure

Reversible cerebrovascular vasoconstriction syndrome

Thunderclap headache, Normal CT LP, sometimes FND and seizure, diffuse arterial beading on angio, 50% post partum or SSRI or cannabis, ¼ SAH, Bed rest nimodipine

Posterior reversible leukoencephalopathy syndrome

Hypertensive emergency, headache, seizure, confusion, vision loss, white matter vasogenic edema in occipital and parietal , manage bp and support

Hypnagogic hallucination (Before sleep)

levitating/out of body experience, treat with TCA

Diabetic amyotrophy

medial Thigh pain, unilateral weakness, muscle quadriceps wasting, loss of knee jerk, femoral distribution, better glycemic control, physiotherapy, neuropathy medication

CVA + DVT, Post water surfacing:

Bubble echo for patent foramen ovale

Diabetic amyotrophy

Diabetic amyotrophy: medial Thigh pain, unilateral weakness, muscle quadriceps wasting, loss of knee jerk, femoral distribution, better glycemic control, physiotherapy, neuropathy medication

Oculovestibular reflex/caloric test

OWS (cold opposite, warm same) fast nystagmus: IF brainstem works, slow phase happens and looks at cold water, then fast looks away

Doll’s eye/Oculocephalic reflex

Intact: Cortex Absent: Brainstem

INO

MLF pons: Affected side eye won't adduct and nystagmus happens *adduction of eyes still occurs during accommodation

Medullary tumors:

Extramedullary: meningioma, schwannoma, hemangioblastoma Intramedullary: Astrocytoma, ependymoma

Periodic paralysis

Periodic paralysis (hypo/hyperkalemia): Autosomal dominant, teen, waking up or after rest, eating too much carbohydrate, never during exercise, after exercise, hypokalemia, treat with Potassium supplement, spironolactone, acetazolamide, gentle exercise in acute attack Thyrotoxic periodic paralysis: Also after exercise and carbohydrate + Hypokalemia Paramyotonia: Autosomal dominant, Cold, exercise Familial periodic paralysis Andersen tawil syndrome: Paralysis + cardiac arrhythmia, Autosomal dominant

Diminished unilateral light touch and two point discrimination cause:

Parietal cortex, MRI

Mixed UMN LMN DD?

Mixed UMN LMN: Motor neuron disease (ALS, PLS+multifocal motor neuropathy),cervical myelopathy, syringomyelia, B12,, Fredreich ataxia, conus medullaris lesion, Multisystem atrophy, Kennedy, Infection (HIV HTLV1, Tertiary syphilis, Post polio syndrome),toxic (Lead), Paraneoplastic motor neuropathy Approach: EMG, NCS, MRI

Autonomic neuropathy

Gastroparesis, nocturnal diarrhea, colon dilation, postural hypotension, large urine residual volume, retrograde ejaculation, impotence *happens in Amyloidosis *does not happen in myasthenia gravis

Treatment of Overactive bladder, Treatment of stress incontinence: Treatment of Overflow Incontinence:

Urge incontinence/overactive bladder: bladder training, Oxybutynin (not elderly, dementia), tolterodine (anti muscarinic receptor) darifenacin, solifenacin mirabegron (B3 agonist, first line if delerium) , reduced cofee/tea Stress incontinence: Pelvic floor exercise, Deluxetine, electrical stimulation, biofeedback device Overflow incontinence: intermittent catheter, Doxazosin

AVM (aneurysm detection)

4 Vessel angiography

Weakness leg, apathetic, non communicative

Weakness leg, apathetic, non communicative: Distal ACA

Neuroleptic malignant syndrome VS serotonin syndrome

Serotonin syndrome: SSRI, MAOI (phenelzine), TCA, anti psychotic, tramadol First benzodiazepine, if unresponsive/severe Cyproheptadine, chlorpromazine supportive Hypertonia, hyperreflexia, hyperthermia, dysarthria, sweating, tremor, myoclonus, dilated pupil, babinski +. faster onset within hours, GI, rhabdomyolysis, high CPK cerebellar more prominent than neuroleptic malignant hypomania (happy drunk state) SSRI+ tramadol/citalopram Neuroleptic malignant syndrome: fluids, bromocriptine + Dantrolene (monotherapy dantrolene increase mortality) fever, lead pipe rigidity, altered consciousness, autonom, normal pupil, rhabdomyolysis, raised CPK, myoglobinuria Can be caused by typical+atypical+Sudden cessation Levodopa, phenothiazine, metoclopramide, tetrabenazine, loxapine, thioxanthenes Serotonin: Over 25h, hyperreflexia, clonus Neuroleptic: Over weeks, brady reflexia, rigidity

In very old people, absent ankle jerks, impaired upward gaze, positive palmomental reflex can all be normal. But absent knee jerks and impaired downward gaze is not normal.

Von Hipple Lindau

Autosomal dominant, Triad Hemangioblastoma Brain, Cerebellum(ataxia+ICP), spine,+retinal (vision loss) cerebellar (ataxia) + kidney (cyst, RCC) + Pheochromocytoma pancreas, liver, epididymal/broad ligament cyst Diagnosis: Genetic test Investigation (annual): MRI brain spine, MRI/CT abdominal, Fundoscopy, FH Management: surgery tumors

16 Random Flashcards

(44 cards)