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MTB 2 Flashcards

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1
Q

Best initial therapy for peripheral neuropathy?

A

Pregabalin or gabapentin
TCAs
Seizure meds

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2
Q

Peripheral neuropathy in biker with pressure on palms of hands, trauma to medial side of elbow?

A

Ulnar N.
Wasting of hypothenar eminence
Pain in 4th and 5th fingers

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3
Q

PN w pressure of inner, upper arm; Sat night palsy, use of crutches?

A

Radial N.

Wrist drop

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4
Q

PN w obesity, pregnancy, sitting w crossed legs?

A

Lateral Cutaneous N of thigh

pain/numbness of outer aspect of one thigh

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5
Q

PN that worsens w walking?

A

Tarsal tunnel - Tibial N

Pain/numbness ankle and sole of foot

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6
Q

PN with high boots, pressure on back of knees?

A

Peroneal N.

Weak foot w/decreased dorsiflexion and eversion

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7
Q

PN seen in typists, carpenters, working w hands

A

Median N
Thenar wasting
Pain/Numbness in first 3 digits

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8
Q

CN 7 Palsy in stroke

A

Pt CAN wrinkle forehead on affected side

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9
Q

CN 7/Bells palsy hearing/taste changes?

A

Hyperacusis - CN7 supplies stapedius = shock absorber on middle ear ossicles
Taste - CN7 supplies sensation of taste anterior 2/3 tongue

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10
Q

Most accurate test for CN7 Palsy?

A

EMG

Nerve conduction

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11
Q

Complication with CN7 palsy?

A

Corneal ulceration

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12
Q

Ab MOA in Guillain Barre?

A

Molecular mimicry

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13
Q

Most specific test for Guillain Barre?

A

EMG

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14
Q

CSF findings for Guillain Barre?

A

Albuminocytologic Dissociation

  • Increased protein in CSF: 800
  • No increase in cell count
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15
Q

What test can differentiate who may die from Guillain Barre?

A

PFTs
- decreased FVC, peak inspiratory pressure
Death = dysautonomia and resp failure
Monitor resp fnc w serial measurements of bedside VC

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16
Q

TX for Guillain Barre?

A

IVIG
OR
Plasmapheresis

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17
Q

What test should be done before IVIG?

A

Check for IgA deficiency

- anaphylactic shock

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18
Q

What vaccine is CI in Guillain Barre?

A 
Trivalent influenza (egg)
Use Tamiflu
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19
Q

Tick Paralysis v Guillain Barre?

A 
Tick 
- Children at nape of neck
- Usually descending, but can be ascending
CSF: 
NO albuminocytologic dissociation 
TX: Remove tick
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20
Q

Myasthenia Gravis presentation

A

Double vision, difficulty chewing
Weakness of limb muscles - worse at END of day
Ptosis
Normal pupillary responses

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21
Q

Best initial test for MG?

A

Ach Receptor Ab

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22
Q

Most Accurate test for MG?

A

EMG

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23
Q

Alternative for erdophonium test?

A

Ice test: place ice on eyelids, decrease temp inhibits Ach esterase -> enzymatic activity requires increased temps that leads to increased Ach in NM Junction

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24
Q

Where do we see Trident tongue?

A

MG

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25
What imaging test should be done with MG?
Chest Xray/CT/MRI | Look for thymoma or thymic hyperplasia
26
Best initial TX for MG?
Pyridostigmine = longer acting | Neostigmine
27
Pathophys for MG?
Abs against Ach Receptors at NM Junction | Decreased Ach Receptors
28
When is thymectomy done in MG?
If meds don't work and pt is under age 60 | If pt is over 60 - Prednisone
29
What is done in an acute myasthenic crisis?
IVIG Plasmapheresis Endotracheal intubation
30
Prior to thymectomy, what do we do?
Plasmapheresis to remove abs by squeezing thymus | Myasthenic crisis can precipitate.
31
What are DDX for difficulty rising from a chair?
1. Lambert Eaton 2. Parkinson Dz 3. Dermatomyositis 4. ALS 5. Hypothyroidism induced myopathy
32
Lambert Eaton Myasthenic syndrome Ass'd with Presentation
Increased muscle strength on repetitive Ctx Small cell Ca DTRs absent, increased thirst, proximal muscles affected
33
How do brain abscesses spread?
Contiguous infxn in sinuses, mastoid air cells, otitis media
34
Presentation of brain abscess
``` HA - nocturnal or morning N/V Fever Seizures Focal neuro findings ```
35
Best initial test for brain abscess
CT or MRI | Ring or contrast enhancing lesion w surrounding edema and mass effect
36
Most accurate test for brain abscess
Brain Bx
37
Tx for brain abscess
Empiric: PCN + metronidazole + Ceftriaxone/Cefepime | Vanco if recent neurosurgery (greater risk of resistant staph)
38
Is brain bx needed for brain abscess?
Yes. necessary to determine precise organism
39
Most common cancers that mets to brain?
``` BLT KC Breast Lung Thyroid Kidney Colon ```
40
MC artery in stroke?
MCA
41
What does MCA supply?
``` Lateral surfaces of brain Temporal lobe Face, arms, hands - motor and sensory Brocas Wernickes ```
42
Deficits seen with MCA stroke?
Weakness or sensory on Contralateral side Homonymous hemianopsia - loss of visual field on opposite side of stroke - look twd side of lesion Aphasia if on dominant side
43
MCA stroke in non-dominant lobe?
Preserved speech, comprehension w confusion | Apraxia - unable to perform tasks when asked
44
ACA stroke deficits?
Contralateral weakness/sensory loss - LE>UE (leg, foot, trunk) Personality/Cognitive defect - confusion Urinary incontinence Leg more than arm weakness
45
PCA stroke deficit?
Ipsilateral sensory of face, 9th and 10th CNs Contralateral sensory loss of limbs Limb ataxia
46
How does a medial cerebellar infarction present?
Vermis Vertigo Nystagmus
47
How does a lateral cerebellar infarction present?
Dizziness Ataxia weakness
48
What is Wallenberg syndrome?
PICA infarction - Ipsilateral Facial sensory loss - Contralateral Body sensory loss - Vertigo, ataxia, dysarthria, dysphagia - Ipsilateral orners
49
What to think of if we see vertigo and nystagmus?
Vestibulocerebellar impairment
50
Best initial test in stroke?
CT without contrast
51
Most accurate test in stroke?
MRI
52
What is CN III Palsy w Contralateral Hemiplegia?
Weber
53
What is CN III Palsy w Contralateral ataxia, athetosis?
Benedikt
54
What is the Tx for a non-hemorrhagic stroke of less than 3 hrs?
Thrombolytics
55
What is the Tx for a non-hemorrhagic stroke of more than 3 hrs?
Aspirin
56
What is the Tx for a hemorrhagic stroke?
Nothing
57
What is the Tx for a stroke pt already on aspirin?
Add dipyridamole OR Switch to Clopidogrel
58
When is Heparin the answer in stroke?
Never. It causes hemorrhagic strokes
59
What are AE's of Ticlopidine?
Neutropenia | TTP
60
When is carotid angioplasty and stenting the answer for strokes?
Never.
61
When do we do endarterectomy?
Symptomatic cerebrovascular disease | More than 70% stenosis
62
When do we do Holter in stroke pts?
Initial EKG is normal, to detect atrial arrthymias
63
Do we use steroids in Guillan Barre
No. No proven benefit
64
When is thymectomy CI?
Age over 60/65 | Pre-pubertal

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