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MTB STEP 3 (R) > MTB 3 - Neurology > Flashcards

MTB 3 - Neurology Flashcards

1
Q

Why can a TIA cause a loss of vision in one eye (amaurosis fugax)?

A

the 1st branch of the internal carotid artery is the ophthalmic artery

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2
Q

What percent of strokes are ischemic?

A

80%

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3
Q

Sxs of anterior cerebral artery stroke:

A

LE > UE weakness Personality changes or psych disturbances Urinary incontinence

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4
Q

Sxs of middle cerebral artery stroke:

A

UE > LE weakness Aphasia (Left-side) Apraxia/neglect (Right side) Eye deviation *toward* the lesion Contralateral homonymous hemianopsia with macular sparing

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5
Q

Sxs of posterior cerebral artery stroke:

A

Prosopagnosia

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6
Q

Sxs of vertebrobasilar artery stroke:

A

Vertigo n/v Vertical nystagmus Dysarthria and dystonia Sensory changes in face and scalp Bilateral findings

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7
Q

Sxs of posterior inferior cerebellar artery stroke (PICA)

A

Ipsilateral face Contralateral body Vertigo + Horner’s

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8
Q

Sxs of lacunar infarcts:

A

*Must be absence of cortical deficits* Ataxia Parkinsonian signs Sensory deficits Hemiparesis (mostly the face) Possible bulbar signs

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9
Q

How long does a noncontrast CT take to become 95% sensitive for ischemic stroke?

A

3-5 days

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10
Q

How long does MRI take to become 99% sensitive for nonhemorrhagic stroke?

A

Within 24 hours

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11
Q

List 8 absolute contraindications to tPA:

A

Hx of hemorrhagic stroke Presence of intracranial mass Active bleeding or surgery within 6 weeks Presence of bleeding disorder CPR within 3 weeks that was traumatic (compressions) Suspicion of aortic dissection Stroke within 1 year Head trauma or brain surgery in last 6 months

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12
Q

What med should you add for all ischemic stroke patients?

A

Statin

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13
Q

What tests are indicated for a stroke patient after you have done your CT and given thrombolytics or aspirin?

A

Echo - looks for clots or vegetations Carotid duplex - Look for stenosis >70% (endarterectomy) EKG - Warfarin if A-fib Holter monitor if the EKG is normal

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14
Q

What additional tests should you do on pts

A

ESR VDRL or RPR ANA, double-standed DNA Protein C and S Factor V Leiden mutation Antiphospholipid syndrome

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15
Q

What should you get the BP down to in ischemic stroke prior to CT? How do you achieve it?

A

185/110 10mg labetalol

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16
Q

Give the tx for status epilepticus:

A

Lorazepam…wait 10-20 minutes. If still there give –> Fosphenytoin …wait 10-20 minutes. If still there give –> Phenobarbital …wait 10-20 minutes. If still there give –> general anesthesia (Propofol, thiopental, or midazolam)

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17
Q

What tests do you do on a pt having a seizure?

A

Na, Ca, Mg, glucose, O2, creatinine Head CT urgently Urine toxicology Liver and renal fxn

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18
Q

When to do an EEG (electroencephalogram)?

A

Only if your initial workup doesn’t reveal the etiology - including CT and MRI of the head

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19
Q

When will you treat after the first seizure?

A

Strong family hx of seizures Abnormal EEG Status epilepticus Non-correctable precipitating cause (brain tumor)

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20
Q

Tx of mild parkinson’s in a pt

A

Anticholinergics (Benztropine or hydroxyzine)

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21
Q

Tx of mild parkinson’s in a pt >60

A

Amantadine (b/c anticholinergics in an elderly pt carry a lot of side-effects)

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22
Q

First line treatment for parkinson’s in a pt with severe sxs (inability to perform ADLs)

A

Levodopa/carbidopa Dopamine agonists (ropinirole, pramipexole)

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23
Q

When is essential tremor present? What’s the tx?

A

At rest and with intention Propranolol

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24
Q

Most common sx in MS

A

Optic neuritis

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25
Q

Other common sxs in MS:

A

Atonic bladder Fatigue Hyperreflexia Spasticity Depression

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26
Q

Best initial test for MS? Most accurate?

A

MRI for both

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27
Q

When to get a CT scan for MS?

A

Never

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28
Q

What to do for MS if MRI is nondiagnostic?

A

LP showing oligoclonal bands

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29
Q

Best initial therapy for MS?

A

Steroids for acute exacerbations

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30
Q

Name some disease-modifying therapies in MS:

A

B-interferon Glatiramer Natalizumab

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31
Q

What is a serious side-effect of Natalizumab?

A

PML

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32
Q

What to order in all patients with memory loss?

A

Head CT B12 T4/TSH RPR or VDRL

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33
Q

Tx of alzheimers?

A

Anticholinesterases (Donepazil, Rivastigmine, galantamine)

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34
Q

Tx of frontotemporal dementia?

A

Same as alzheimers (less efficacy though)

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35
Q

What causes CJD?

A

Prions

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36
Q

How does CJD present?

A

Rapidly progressive dementia Myoclonus Pt is younger than in alzheimers

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37
Q

Best initial test for CJD?

A

LP which shows 14-3-3 protein (if present it spares the need for a brain biopsy)

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38
Q

Most accurate diagnostic test for CJD?

A

Brain biopsy

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39
Q

Describe Lewy Body dementia:

A

Parkinson’s w/ dementia Vivid, detailed hallucinations caused by alpha synuclein defect

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40
Q

Triad of NPH: - a/w Alzheimers

A

Urinary incontinence Dementia Wide-based gait/ataxia

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41
Q

How to diagnose NPH?

A

Head CT LP showing normal pressure MOA: no increase in SA space volume, expansion of ventricles compresses fibers of corona radiate and causes the triad of symptoms

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42
Q

Tx of NPH?

A

Shunt

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43
Q

Sxs of Huntington’s?

A

Look for family hx since it’s inherited Dementia Psychiatric disturbance w/personality change Chorea/movement disorder

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44
Q

How to diagnose Huntington’s?

A

Genetic testing Autosomal dominant

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45
Q

Tx of Huntington’s?

A

Tetrabenazine for movement disorder Antipsychotics for symptom control

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46
Q

When should you get a CT or MRI for headaches?

A

Sudden and/or severe Onset after age 40 Focal neurological findings

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47
Q

When do you give migraine prophylaxis? What do you give for it?

A

Propranolol if >4 headaches per month CCB, TCA, SSRI also work All these will take several weeks to take effect

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48
Q

How do triptans work to abort migraines?

A

Constrict vessels -This is why they’re dangerous in HTN, pregnancy, and CAD (causing cardiac ischemia)

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49
Q

How do cluster HAs present?

A

Unilateral Redness and tearing of eye Rhinorrea Men > women by 10 to 1 *No aura*

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50
Q

Tx of Cluster headaches:

A

Abortive: 100% O2 or triptans Prophylaxis: CCB (Verapamil)

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51
Q

Presentation of Temporal arteritis:

A

Tenderness over temporal area Jaw claudication

52
Q

Tx of temporal arteritis?

A

Steroids BEFORE biopsy to prevent vision loss

53
Q

Dx of temporal arteritis?

A

ESR Temporal artery biopsy

54
Q

Presentation of pseudotumor cerebri:

A

Young obese woman HA Diplopia 6th nerve palsy Visual field loss Transiently obscure vision Pulsatile tinnitus

55
Q

All pts with vertigo will have ___

A

Nystagmus

56
Q

All pts with vertigo should have a ____

A

MRI of the internal auditory canal

57
Q

List 6 diseases that cause vertigo:

A

BPV Vestibular neuritis Labyrinthitis Meniere’s Acoustic neuroma Perilymph fistula

58
Q

Which of the 6 disease that cause vertigo also cause hearing loss/tinnitus?

A

Labyrinthitis Meniere’s Acoustic neuroma Perilymph fistula

59
Q

How does BPV present?

A

Vertigo alone with position changes Tx: Epley maneuver. Meclizine has modest efficacy

60
Q

What is vestibular neuritis, how does it present, and what is the tx?

A

Inflammation of only the vestibular portion of CN VIII. No hearing loss/tinnitus (cause only vestibular part is affected) Tx: Meclizine

61
Q

What is labyrithitis, how does it present, and what is the tx?

A

Inflammation of cochlea Vertigo, hearing loss and tinnitus Acute and self-limited Can treat with meclizine and steroids

62
Q

How does meniere’s disease present?

A

Vertigo, hearing loss, tinnitus (just like labyrinthitis) Ear fullness *Chronic and remitting episodes* Tx: Salt restriction and diuretics

63
Q

Acoustic neuromas (Vestibular schwannoma) can be related to what?

A

Neurofibromatosis - type 2: BL benign primary intracranial tumor of the myelin-forming cells of the vestibulococholear nerve (CN8)

64
Q

How does an acoustic neuroma present?

A

Ataxia Hearing loss, tinnitus, vertigo

65
Q

Dx and tx of acoustic neuroma?

A

MRI of auditory canal Surgical resection

66
Q

What is a perilymph fistula?

A

Rupture of tympanic membrane from either trauma/barotrauma that leads to a perilymph fistula. Tx is fixing the hole surgically

67
Q

How does Wernicke-Korsakoff syndrome present?

A

Hx of alcoholism Confusion/confabulation Ataxia Memory loss Gaze palsy/ophthalmoplegia Nystagmus

68
Q

Tx of wernicke-korsakoff syndrome?

A

Thiamine, then glucose

69
Q

Most accurate test for bacterial meningitis?

A

Culture

70
Q

Pt has bacterial meningitis. What is the organism if the Gram stain shows: Gram-positive diplococci? Gram-negative diplococci? Gram-negative coccobacillary organisms? Gram-positive bacilli?

A

Gram-positive diplococci = Pneumococcus Gram-negative diplococci = Neisseria Gram-negative coccobacillary organisms = Haemophilus Gram-positive bacilli = Listeria

71
Q

What CSF glucose level is consistent with bacterial meningitis?

A

When it’s

72
Q

In whom does cryptococcus infect?

A

HIV-patients with

73
Q

Best initial test for cryptococcus? Most accurate?

A

Initial: India Ink Accurate: Cryptococcal antigen

74
Q

Best initial therapy for cryptococcus?

A

Amphotericin and 5-flucytosine - Add fluconazole if CD4 doesn’t rise

75
Q

Tx of Lyme?

A

IV ceftriaxone or penicillin

76
Q

Describe Rocky Mountain Spotted Fever. What is the tx?

A

Starts on wrists -Fever, HA and malaise *precede* the rash Tx: Doxycycline

77
Q

How does TB meningitis present?

A

Like bacterial, but much slower. If sxs come on over hours, it’s not TB

78
Q

Tx of TB meningitis?

A

RIPE + Steroids

79
Q

Unique CSF finding in TB meningitis?

A

Very high protein level

80
Q

How does Neisseria meningits present? What should you always do to patients with Neisseria meningitis?

A

Adolesecent w/petechial rash and high neutrophils on CSF Place them in *respiratory isolation* *Prophylaxis for close contacts* with rifampin, cipro, or ceftriaxone

81
Q

How does listeria meningitis present? Tx?

A

Elderly and neonatal and HIV patients Pts with no spleen Pts on steroids Immunocompromised *Add ampicillin to therapy!*

82
Q

Fever + confusion = ___

A

encephalitis

83
Q

Almost all encephalitis in the US is caused by ___

A

Herpes

84
Q

How to diagnose encephalitis?

A

Head CT first PCR of CSF 2nd (most accurate)

85
Q

Best tx for herpes encephalitis?

A

Acyclovir Foscarnet if resistant to acyclovir

86
Q

How does acyclovir work?

A

Inhibits tyrosine kinase

87
Q

How does a brain abscess present?

A

Fever, HA, focal neuro deficits CT shows a *contrast-enhancing* ring

88
Q

How to manage an abscess in an HIV-negative pt?

A

Brain biopsy

89
Q

How to manage an abscess in an HIV patient?

A

Treat for toxoplasmosis: *Pyrimethamine and sulfadiazine for 2 weeks and repeat CT*

90
Q

What is PML?

A

Progressive Multifocal Leukoencephalopathy -In HIV pts -No ring enhancement -Tx is just to raise CD4 with HIV drugs

91
Q

Presentation of neurocysticercosis:

A

Pt from Mexico with a seizure

92
Q

What does head CT show in neurocysticercosis?

A

Multiple 1 cm cystic lesions Over time they will calcify

93
Q

Tx of neurocysticercosis?

A

Albendazole if not yet calcified Anti-epileptic drugs if calcified

94
Q

Who should receive stress ulcer prophylaxis? What do they get?

A

Give PPIs to pts with: -Head trauma -Burns -Endotracheal intubation with mechanical ventilation

95
Q

Sxs of subarachnoid hemorrhage?

A

Thunderclap Stiff neck Photophobia LOC in 50% of pts Focal neuro deficits

96
Q

How to diagnose a SAH?

A

Head CT If inconclusive, do LP

97
Q

How to know if an increased WBC count in the CSF is from infection or just from blood?

A

Ratio of WBC:RBCs *1:500 is normal* *>1:500 signals infection*

98
Q

Tx of SAH?

A
  1. Angiography to determine site of bleeding 2. Embolize bleeding site (superior to clipping) 3. Nimodipine to prevent stroke from vasospasm
99
Q

What’s the pathophysiology, causes, sxs, dx, and tx of syringomyelia?

A

Pathophys: Defective fluid cavity in the center of the cord Causes: Trauma, tumors, congenital problem Sxs: Capelike loss of pain/temp sensation and down UEs Dx: MRI Tx: Surgically

100
Q

Can cord compression from metastatic tumors cause pain and tenderness in the spine?

A

Yes

101
Q

How does a spinal epidural abscess present?

A

Back pain + tenderness + fever

102
Q

Tx of spinal epidural abscess?

A

Oxacillin/nafcillin

103
Q

When is pain the worst with spinal stenosis?

A

LE pain when walking downhill

104
Q

Dx and tx of spinal stenosis?

A

Dx: MRI Tx: Surgical decompression

105
Q

Describe Brown-Seguard syndrome:

A

Loss of: -Ipsilateral motor fxn -Contralateral pain and temperature sense

106
Q

Most urgent step in management of cord compression?

A

Steroids to relieve pressure on the cord

107
Q

When is the diagnosis of cord compression clear?

A

Back pain + tenderness + hyperreflexia of the legs

108
Q

Signs of ALS:

A

UMN: Hyperrflexia, Weakness, Spasticity LMN: Muscle wasting, fasciculations

109
Q

Tx of ALS and how does it work?

A

Riluzole Blocks accumulation of glutamate

110
Q

Radial nerve palsy results in ____

A

Wrist drop

111
Q

Peroneal nerve palsy results in ____

A

Foot drop Loss of foot eversion

112
Q

What can cause peroneal nerve palsy?

A

High boots pressing at the back of the knee

113
Q

Sxs of Bell’s Palsy:

A

Hemifacial paralysis Loss of taste on anterior 2/3rd of tongue (CN VII) Hyperacusis d/t loss of stapedius control (the shock absorber)

114
Q

Tx of Bell’s?

A

Steroids

115
Q

What is reflex sympathetic dystrophy also known as?

A

Chronic regional pain syndrome

116
Q

In whom does reflex sympathetic dystrophy (Chronic regional pain syndrome) effect?

A

Pts with previous injury to the extremity

117
Q

Sxs of Chronic regional pain syndrome:

A

Extreme pain of burning quality upon light touch

118
Q

Tx of chronic regional pain syndrome?

A

NSAIDs Gabapentin Occasionally nerve block

119
Q

Tx of RLS?

A

Pramipexole or ropinirole (dopamine agonists)

120
Q

Best initial test for myasthenia?

A

Anti-acetylcholine receptor antibodies

121
Q

Best initial tx of myasthenia?

A

Pyridostigmine or neostigmine

122
Q

What to do for myasthenic pts if initial meds don’t work?

A

Thymectomy (if pt is

123
Q

What to do if thymectomy doesn’t work for myasthenic pts?

A

Prednisone

124
Q

Sxs of myasthenia?

A

Weakness in muscles of mastication (can’t finish meals) Blurry vision Diplopia Ptosis

125
Q

What can be used for myasthenia in order to keep patients off of long-term steroids?

A

Azathioprine and cyclosporine

126
Q

How do cyclosporine and azathioprine work?

A

Inhibit the immune system by altering T-cells so they can’t function as well

MTB STEP 3 (R) (9 decks)

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