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Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

anterior cord syndrome

associated with ____ fractures

A

infarct of anterior spinal a., ant 2/3 spinal cord affected

loss of
motor (gray and lcst)
pain and temp (acst, astt, lstt)

preservation of
position and vibratory sensation

associated with burst fracture of vertebra, eg jumping from building landing on feet

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2
Q

hemiballismus
what is it
what causes it

A

unilateral chorea of proximal muscles

vascular disease of contralateral STN subthamic nucleus

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3
Q

tetrabenazine moa

A
  • | VMAT2
    dec monoamine uptake and signaling
    (dopamine serotonin e ne h)
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4
Q

reserpine moa

A

depletes peripheral catecholamines, dec sns, vasodilation and sedation

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5
Q

what is chorea

what are 2 etiologies?

A

rapid irregular unpredictable involuntary muscle jerks

caudate and putamen cell losses
dopaminergic agonists

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6
Q

akathisia

colloquial synonymn

A

restlessness

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7
Q

postural tremor

A

tremor w holding position against gravity, eg holding arms outstretched

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8
Q

2 adjectives for tremor

A

rhythmic oscillatory

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9
Q

3 most common bugs in brain abscess

A

strep v
staph a
gnrs

so empiric tx ceftri vanc metro

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10
Q

empiric tx brain abscess

A

ceftri strep v
vanc staph a
metro gnrs

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11
Q

typical ct finding in hsv encephalitis

A

hypodense lesion in parietal lobe

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12
Q

when is pt at risk for nocardia brain abdcess

A

cd4 v100/mm3

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13
Q

tf

rhizopus causes brain abscesses

A

f
mucormycosis can spread from sinuses thru bone to brain but is highly destructive and necrotizing not abscess forming usually

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14
Q

tf

cerebral toxoplasmosis typically causes single ring enhancing lesion

A

f

multiple usually

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15
Q

when is pt at risk for toxoplasmosis

A

cd4 v100

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16
Q

tf

cd4 v100 is risk for toxo and nocardia both

A

t

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17
Q

single brain abscess usually results from

A

direct extension of sinusitis otitis media dental infection

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18
Q

central cord syndrome

A

hyperextension inj in eld w preexisting c-spine degenerative change – selective cst and lstt damage, maybe stt. ue motor weakness more than le as ue mn more midline, maybe some pain and temp loss from stt

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19
Q

brown sequard syndrome

A

hemisection of soinal cord eg from penetrating injury
below lesion
ipsi weakness spasticity vib and prop loss
contra pain temp loss

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20
Q

tf

cerebral contusion produces fnd’s

A

both

can oroduce fnd’s, but also ams and risk of seizure from edema

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21
Q

posterior cord syndrome

A

vib and prop loss and maybe weakness paresthesias urinary incontinence retention

eg from ms or vertebral a dissection

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22
Q

spondylosis

A

degeneration of spinal column from any cause, most commonly oa osteoarthritis

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23
Q

diff in pres of wilsons in kid/adolescent vs adult

A

kid/ado typically liver – asymp transaminitis to fulminant liver failure

adults typ neuropsych from tremor rigidity to depression catatonia paranoia

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24
Q

confirm dx of suspected wilsons

A

low ceruloplasmin v20
confirm w urine cu excretion
and slit lamp to look for kayser fleischer rings

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25
Q

how to look for keyser fleischer rings in wilsons

A

slit lamp test

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26
Q

what causes the neurological sympx of wilsons

A

cu dep in basal ganglia

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27
Q

at what age does hemochromatosis typ present

A

after age 40

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28
Q

another name for mallory body

A

mallory hyaline

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29
Q

tf

mallory body = mallory hyaline, same thing

A

t

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30
Q

what do mallory bodies suggest

A

alcoholic hepatitis
OR
wilsons

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31
Q

tf

mallory bodies on liver biopsy are associated w wilsons

A 
t
mallory bodies assoc w
alc hepatitis
OR
wilsons
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32
Q

liver bx in a1-antitrypsin deficiency

A

pas + , diastase resistant granules in hepatocytes

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33
Q

pas + , diastase resistant granules in hepatocytes on liver bx suggests

A

a1-antitrypsin deficiency

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34
Q

4 precipitators of myasthenic crisis

A

infection sx
pregnancy child birth
tapering immunosuppressants
meds like aminoglycs an bb’s

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35
Q

s&s

myasthenic crisis

A

general weakness oropharyngeal weakness/swallow difficulty

resp insuffic dyspnea

36
Q

tx myasthenic crisis

A

intubate for deteriorating resp status

ivig plasmapheresis corticosteroids

37
Q

precipitants, s&s, tx myasthenic crisis

A

sx inf preg labor taper immunosuppressant aminoglyc bb

gen weak oropharyngeal weak swallow diff resp insuf dyspnea

intubate for bad breathing
ivig plasmapheres corticosteroids

38
Q

what is syringobulbia

A

when fluid cavities (syrinxes.. eg congenital, tumor, trauma) affect brain stem

causing eg ipsi tongue wasting, palatal weakness, vocal cord paralysis, trigeminal sensory loss

39
Q

define bleeding diathesis

A

susceptibility to bleed

usually hypocoagulability caused by coagulopathy

40
Q

define tabes dorsalis

A

syphilitic myelopathy causing demyelination of dorsal columns - impaired vib prop descriminatory touch

unsteadiness, suddem lancinating pian, u incont

41
Q

synonymn for reflex sympathetic dystrophy

A

complex regional pain syndrome

42
Q

ai dry eyes dry mouth think…

A

sjogren syndrome

43
Q

are symptoms of limbar spinal stenosis worse w standing and downhill walking or sitting and uphill walking

A

worse w standing and downhill walking

ext of spine narrows canal
flex of spine widens canal

44
Q

rule out lumbar spinal stenosis w this test

A

mri

45
Q

ankle brachial index

A

ankle bp / brachial bp

nl 1 - 1.4

46
Q

normal ankle brachial index

A

1-1.4

ankle ^ or = brachial

47
Q

what do bone scans identify

A

high bone turnover

eg mets, fractures, osteomyelitis

48
Q

wallenberg syndrome

A
  • lateral medullary infarct of intracranial vertebral a
  • vestibulocerebellar vertigo fall to ipsi, horiz and vert nystag diplopia, ipsi limb atax
  • sensory loss of ipsi face pain temp (spinotrigem) contralat trunk limbs pain temp (spinothalam)
  • bulbar ipsi dysphag aspirate dysarth dysphon hoarseness diminished gag reflex (nuc ambig, cn IX and cn X)
  • autonomic ipsi horner hiccup impaired invol breathing espec in sleep
49
Q

lesion if lateral cerebellum produces what sympx

A

ipsi atax w minimal dizziness

50
Q

leaion of lateral medulla produces what symptoms

A

wallenberg syndrome

  • vestibulocerebellar vertigo fall to ipsi, horiz and vert nystag diplopia, ipsi limb atax
  • sensory loss of ipsi face pain temp (spinotrigem) contralat trunk limbs pain temp (spinothalam)
  • bulbar ipsi dysphag aspirate dysarth dysphon hoarseness diminished gag reflex (nuc ambig, cn IX and cn X)
  • autonomic ipsi horner hiccup impaired invol breathing espec in sleep
51
Q

lateral mid pontine lesion sympx

A

ipsi mastication weakness
tactile and position sense dim

motor and sensory trigem nuclei

52
Q

medial medullary syndrome

A
  • medial pyramid contralat hemiplegia
  • medial lemniscus contralat tact vib position loss
  • hypoglossal nerve ipsi tongue weak deviate to lesion
53
Q

medial mid pontine syndrome

A

contralat ataxic hemiplegia of face trunk limbs, maybe tact and position loss too

54
Q

R ataxic hemiplegia of face trunk limbs, maybe tact and position loss too

where is the lesion?

A

L medial mid pontine

55
Q

L hemiplegia tact position vib loss
R tongue dev

where is the lesion?

A

R medial medulla

pyramid contra hemipleg, medial lemniscus contra tact vib position, hypoglossal nerve ipsi tongue motor

56
Q

R mastication weakness
tactile and position sense loss

where is the lesion

A

R lateral mid pontine

motor and sens trigem nuclei

57
Q

vertigo fall to L, horiz and vert nystag diplopia, L limb atax, L face sensory loss face pain temp, R trunk limbs pain temp loss, L dysphag aspirate dysarth dysphon hoarseness diminished gag reflex, L horner hiccup impaired invol breathing espec in sleep, other motor spared
where is the lesion?

A 
L lateral medulla
ipsi vestibulocerebellar
ipsi spinaltrigem
contra spinalthalam
ipsi nuc ambig cnIX cnX
ipsi sypathetic

= wallenberg syndrome

58
Q

Vimpat (lacosamide) use and moa

A

tx seizures

enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing

59
Q

generic for Vimpat

A

lacosamide
tx seizures
enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing

60
Q

brand for lacosamide

A

Vimpat
tx seizures
enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing

61
Q

generic for Dilantin

A

phenytoin
tx seizures
modulates neuronal VNaCs and CaCs

62
Q

brand for phenytoin

A

Dilantin
tx seizures
modulates neuronal VNaCs and CaCs

63
Q

Dilantin generic, use, moa

A

phenytoin
tx seizures
modulates neuronal VNaCs and CaCs

64
Q

Aricept generic, use, moa

A

donepezil
tx Alzheimer’s
-| AchE

65
Q

Bipolar I
define
tx options
avoid

A

1+ manic episode
+/- hypomanic or depressive episode
mood stabilizers Li+, VPA, carbamazepine, atypical antipsychotics (-piprazole, -apines, -idones)
avoid antideps, can precipitate mania

66
Q

Bipolar II
define
tx options
avoid

A

1+ hypomanic episode
1+ depressive episode (tx options same as BP I) mood stabilizers Li+, VPA, carbamazepine, atypical antipsychotics (-piprazole, -apines, -idones)
avoid antideps, can precipitate mania

67
Q

sq nodules
dark skin spots
bilateral deafness
in the family

A

neurofibromatosis 2

AD tumor suppressor mut ch22

68
Q

rank the following by stroke risk

htn dm hld smoking alc

A

htn #1
smoking ~ dm
hld mild at best
mod alc protective, inc hdl

69
Q

typical presentation sympx of myasthenia gravis

A

extraocular diplopia ptosis
bulbar dysphagia dysarthria
ue symmetric proximal weakness

70
Q

diplopia ptosis
dysphagia dysarthria
ue symmetric proximal weakness
end of day

A

myasthenia gravis

ai abs to motor end plate ach rs

71
Q

tf
in myasthenia gravis
sensation, reflexes, muscle bulk and tone, ANS
usually intact

A

t

72
Q

lesions of subcortical nuclei (eg basal ganglia) usually result in

A

extrapyramidal sympx
rigidity, bradykinesia, tremor, chorea
like in
pd, hd,

73
Q

ms typically affects women v50

A

t

74
Q

tf

myasthenia gravis tends to affect proximal ue more than le

A

t

neck, prox ue, extraoc, bulbar

75
Q

tx acute ms flare w debilitating sympx

A

iv methylprednisone

plasmapheresis if refractory to steroids

76
Q

what are the ms dma’s and when tkmo consider them

A

ifn b
glatiramer acetate

chronic maintainence in rrms or spms

77
Q

trihexphenidyl
moa
uses

A

anticholinergic
tx pd
tx drug induced extrapyramidal sympx

78
Q

beet bone hare bat hatter flask

describe what class of se’s

A

anticholinergic
red dry hot mad blind full
flush, anhydros dry mouth, hypertherm, delirium confusion, mydriasis, u retention b constipation

headache glaucoma dizziness tachycard too

79
Q

tf

headache and glaucoma are anticholinergic se’s

A

t
red dry hot mad blind full
flush, anhydros dry mouth, hypertherm, delirium confusion, mydriasis, u retention b constipation

headache glaucoma dizziness tachycard too

80
Q

levodopa se’s

donthe change w carbidopa?

A

nausea vomiting wo carbi

agitaton psychosis w or wo carbi

81
Q

serotonin syndrome

and 2 drug classes that cause it

A

agitation confusion sometimes sz
tachycard
muscle rigidity

ssri
tca
espec if coadmin w maobi selegiline

82
Q

name 6 ssri’s

A 
citalopram
escitalopram
paroxetine
fluoxetine
fluvoxamine
sertraline
83
Q

ataxia telangiectasia

A

inherited autosomal recessive disorder with its onset in infancy characterized by progressive cerebellar ataxia, oculocutaneous telangiectasia, and immunologic deficiency. also cancer risk
mut atm dna repair gene

84
Q

choreoathetosis

A

chorea - irreg migrating contractions
+ athetosis - twisting and writhing
both involuntary

85
Q

inner ear disease thay causes episodes of vertigo

A

meniere disease

86
Q

tf

increase dose of home pyridostigmine for myasthenia crisis after intubation

A

f
hold ache inhibs to reduce airway secretions and aspiration risk, at least temporarily

plasmapheresis pref to ivig
and corticosteroids
can consider azothioprine or myclophenoloate mofetil for immune immodulation if corticosteroids ineffective but take weeks to work

Medicine (13 decks)

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