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Flashcards in Misc. Deck (32):
1

pseudotumor cerebri px

-severe headache
-obese woman on OCP*
-papilledema*
-Cr VI palsy --> diplopia

-vit A toxicity is a less common cause

2

pseudotumor cerebri test results

-negative CT, MRI
-LP --> increased CSF pressure

~70% have empty sella on CT

3

pseudotumor cerebri tx

-weight loss
-acetazolamide (to dec CSF fluid production)

-optic nerve sheath decompression (when refractory to medical therapy)

4

trigeminal neuralgia px, tx

-severe pain over trigeminal distribution of Cr V
-exacerbated by chewing, talking, touching area

-tx: carbamazepine, surgical resection of nerve

5

Guillian-Barre syndrome px

-ascending paralysis
-post Campylobacter jejuni infection
-autoimmune: Ab against myelin
-acute, inflammatory, polyneuropathy
-absent DTRs

-death from diaphragm paralysis --> resp failure

6

Guillian-Barre syndrome tx

-IVIG = best initial
-plasmapheresis (remove Ab against myelin)

-both have equal efficacy, but don't combine
-NO steroids

-intubate if FEV1 dec

7

Guillian-Barre syndrome dx

-lumbar puncture = best initial
(inc protein, normal cell count; albumin-cytologic dissociation)

-electromyelography = most accurate
(nerve conduction velocity study)

-PFTs to assess diaphragm strength (FVC)

8

myasthenia gravis =?

antibodies against ACh-R in neuromuscular junction

-dec impulse conduction --> dec strength
-autoimmune

9

myasthenia gravis px

-weakness: diplopia, ptosis, dysphagia
-nasal speech, snarling smile
-intact DTRs, normal pupillary reflex

10

myasthenia gravis dx

-acetylcholine-receptor antibodies = best initial
(less diagnostic with symptoms limited to eyes compared to generalized symptoms)

-edrophonium (tensilon, ACh-E-I) test --> sensitive, but not specific
-CXR (rule out thymoma)
-EMG = most accurate

11

Eaton-Lambert syndrome px

-initial weakness, which improves over time with repetitive movement (builds up [Ca] --> overcomes Ab)

-antibodies against Ca-channels
-small cell lung cancer association

12

myasthenia gravis tx

-pyridostigmine or neostigmine = best initial
(long term ACh-esterase-inhibitors --> inc [ACh])

-thymectomy (13-60 YO)
-steroids vs azathioprine, cyclosporine, cyclophosphamide (>60 YO)

13

acute myasthenic crisis px, tx

-significant paralysis --> resp symptoms
-tx: plasmapheresis & IVIG

14

antibiotic class that causes myasthenia gravis-like symptoms?

aminoglycosides
(gentamicin, tobramycin, amikacin)

15

amylotrophic lateral sclerosis

=motor neuron disease
-motor cell bodies die
-UPPER & LOWER motor neuron affected
-sensory, cognition, bowel/bladder all intact

16

UMN px

-weakness
-hyperreflexia --> from lack of inhibition
-spasticity --> from hyper reflexive arc

"squeezing b/t two fat ppl"

17

LMN px

-muscle wasting
-muscle atrophy
-fasciculations

"puppet-like"

18

ALS tx

-supportive

-riluzole --> slows destruction of motor neurons

(often die from respiratory paralysis or repeated infections)

19

multiple sclerosis

-autoimmune demyelinating disease
-white matter plaques

-optic neuritis = most common px
-motor --> weakness
-sensory, bowel/bladder
-can px with trigeminal neuralgia

20

MS causes

-genetic
-areas away from malaria (cold regions)

21

MS types

-relapsing remitting
-primary progressive
-secondary progressive

progressive disability; RR improves slightly during this downgrade

22

MS px

-multiple neurological deficits
-optic neuritis
-paresthesias
-bowel/bladder spasticity

-mentation intact the longest

23

MS dx

-MRI = best initial, most accurate
(multiple plaques in the WHITE matter)

-LP: inc protein, mildly inc cell count

-oligoclonal bands = IgG in CSF; used in an inconclusive MRI
-evoked potentials: old test

24

MS tx

-steroids: acute severe
-plasma exchange (those refractory to steroids)

-disease-modifying --> interferon-beta & glatiramir: acute exacerbations
(replaces myelin basic protein)

25

MS symptomatic tx?
spasticity
trigeminal neurlagia
bladder hypperreactivity
urinary retention
fatigue
erectile dysfunction

-baclofen*; tizanfine, diazepam
-carbamazepine, gabapentin, phenytoin, TCA
-oxybutynin (blocks ACh)
-bethanechol (gives ACh)
-amantidine, fluoxetine (SSRI)
-sildenafil

26

lacunar stroke cause? location? types?

-HTN

-posterior limb, VPN, anterior limb, pontis

27

pure motor stroke location? symptoms?

-posterior limb of internal capsule

-unilateral motor deficit, mild dysarthria

28

pure sensory stroke location? symptoms?

-VPN of thalamus

-unilateral numbness, paresthesias (face & body)

29

ataxic-hemiparesis stroke location? symptoms?

-anterior limb of internal capsule

-lower extremity weakness
-ipsilateral arm/leg incoordination

30

dysarthria-clumsy hand syndrome?

-lacunar stroke at basis pontis (where the basilar artery runs)

-hand weakness, mild motor aphasia

31

heat stroke px?

-acute confusion
-hyperthermia (>105F)
-tachycardia
-coagulopathic bleeding

32

Lhermitte's sign

transient electric-like shock down spinal, triggered by flexion of neck