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

MTB 3 - Neurology Flashcards

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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
Other common sxs in MS:
Atonic bladder Fatigue Hyperreflexia Spasticity Depression
26
Best initial test for MS? Most accurate?
MRI for both
27
When to get a CT scan for MS?
Never
28
What to do for MS if MRI is nondiagnostic?
LP showing oligoclonal bands
29
Best initial therapy for MS?
Steroids for acute exacerbations
30
Name some disease-modifying therapies in MS:
B-interferon Glatiramer Natalizumab
31
What is a serious side-effect of Natalizumab?
PML
32
What to order in all patients with memory loss?
Head CT B12 T4/TSH RPR or VDRL
33
Tx of alzheimers?
Anticholinesterases (Donepazil, Rivastigmine, galantamine)
34
Tx of frontotemporal dementia?
Same as alzheimers (less efficacy though)
35
What causes CJD?
Prions
36
How does CJD present?
Rapidly progressive dementia Myoclonus Pt is younger than in alzheimers
37
Best initial test for CJD?
LP which shows 14-3-3 protein (if present it spares the need for a brain biopsy)
38
Most accurate diagnostic test for CJD?
Brain biopsy
39
Describe Lewy Body dementia:
Parkinson's w/ dementia Vivid, detailed hallucinations caused by alpha synuclein defect
40
Triad of NPH: - a/w Alzheimers
Urinary incontinence Dementia Wide-based gait/ataxia
41
How to diagnose NPH?
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
42
Tx of NPH?
Shunt
43
Sxs of Huntington's?
Look for family hx since it's inherited Dementia Psychiatric disturbance w/personality change Chorea/movement disorder
44
How to diagnose Huntington's?
Genetic testing Autosomal dominant
45
Tx of Huntington's?
Tetrabenazine for movement disorder Antipsychotics for symptom control
46
When should you get a CT or MRI for headaches?
Sudden and/or severe Onset after age 40 Focal neurological findings
47
When do you give migraine prophylaxis? What do you give for it?
Propranolol if \>4 headaches per month CCB, TCA, SSRI also work All these will take several weeks to take effect
48
How do triptans work to abort migraines?
Constrict vessels -This is why they're dangerous in HTN, pregnancy, and CAD (causing cardiac ischemia)
49
How do cluster HAs present?
Unilateral Redness and tearing of eye Rhinorrea Men \> women by 10 to 1 \*No aura\*
50
Tx of Cluster headaches:
Abortive: 100% O2 or triptans Prophylaxis: CCB (Verapamil)
51
Presentation of Temporal arteritis:
Tenderness over temporal area Jaw claudication
52
Tx of temporal arteritis?
Steroids BEFORE biopsy to prevent vision loss
53
Dx of temporal arteritis?
ESR Temporal artery biopsy
54
Presentation of pseudotumor cerebri:
Young obese woman HA Diplopia 6th nerve palsy Visual field loss Transiently obscure vision Pulsatile tinnitus
55
All pts with vertigo will have \_\_\_
Nystagmus
56
All pts with vertigo should have a \_\_\_\_
MRI of the internal auditory canal
57
List 6 diseases that cause vertigo:
BPV Vestibular neuritis Labyrinthitis Meniere's Acoustic neuroma Perilymph fistula
58
Which of the 6 disease that cause vertigo also cause hearing loss/tinnitus?
Labyrinthitis Meniere's Acoustic neuroma Perilymph fistula
59
How does BPV present?
Vertigo alone with position changes Tx: Epley maneuver. Meclizine has modest efficacy
60
What is vestibular neuritis, how does it present, and what is the tx?
Inflammation of only the vestibular portion of CN VIII. No hearing loss/tinnitus (cause only vestibular part is affected) Tx: Meclizine
61
What is labyrithitis, how does it present, and what is the tx?
Inflammation of cochlea Vertigo, hearing loss and tinnitus Acute and self-limited Can treat with meclizine and steroids
62
How does meniere's disease present?
Vertigo, hearing loss, tinnitus (just like labyrinthitis) Ear fullness \*Chronic and remitting episodes\* Tx: Salt restriction and diuretics
63
Acoustic neuromas (Vestibular schwannoma) can be related to what?
Neurofibromatosis - type 2: BL benign primary intracranial tumor of the myelin-forming cells of the vestibulococholear nerve (CN8)
64
How does an acoustic neuroma present?
Ataxia Hearing loss, tinnitus, vertigo
65
Dx and tx of acoustic neuroma?
MRI of auditory canal Surgical resection
66
What is a perilymph fistula?
Rupture of tympanic membrane from either trauma/barotrauma that leads to a perilymph fistula. Tx is fixing the hole surgically
67
How does Wernicke-Korsakoff syndrome present?
Hx of alcoholism Confusion/confabulation Ataxia Memory loss Gaze palsy/ophthalmoplegia Nystagmus
68
Tx of wernicke-korsakoff syndrome?
Thiamine, then glucose
69
Most accurate test for bacterial meningitis?
Culture
70
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?
Gram-positive diplococci = Pneumococcus Gram-negative diplococci = Neisseria Gram-negative coccobacillary organisms = Haemophilus Gram-positive bacilli = Listeria
71
What CSF glucose level is consistent with bacterial meningitis?
When it's
72
In whom does cryptococcus infect?
HIV-patients with
73
Best initial test for cryptococcus? Most accurate?
Initial: India Ink Accurate: Cryptococcal antigen
74
Best initial therapy for cryptococcus?
Amphotericin and 5-flucytosine - Add fluconazole if CD4 doesn't rise
75
Tx of Lyme?
IV ceftriaxone or penicillin
76
Describe Rocky Mountain Spotted Fever. What is the tx?
Starts on wrists -Fever, HA and malaise \*precede\* the rash Tx: Doxycycline
77
How does TB meningitis present?
Like bacterial, but much slower. If sxs come on over hours, it's not TB
78
Tx of TB meningitis?
RIPE + Steroids
79
Unique CSF finding in TB meningitis?
Very high protein level
80
How does Neisseria meningits present? What should you always do to patients with Neisseria meningitis?
Adolesecent w/petechial rash and high neutrophils on CSF Place them in \*respiratory isolation\* \*Prophylaxis for close contacts\* with rifampin, cipro, or ceftriaxone
81
How does listeria meningitis present? Tx?
Elderly and neonatal and HIV patients Pts with no spleen Pts on steroids Immunocompromised \*Add ampicillin to therapy!\*
82
Fever + confusion = \_\_\_
encephalitis
83
Almost all encephalitis in the US is caused by \_\_\_
Herpes
84
How to diagnose encephalitis?
Head CT first PCR of CSF 2nd (most accurate)
85
Best tx for herpes encephalitis?
Acyclovir Foscarnet if resistant to acyclovir
86
How does acyclovir work?
Inhibits tyrosine kinase
87
How does a brain abscess present?
Fever, HA, focal neuro deficits CT shows a \*contrast-enhancing\* ring
88
How to manage an abscess in an HIV-negative pt?
Brain biopsy
89
How to manage an abscess in an HIV patient?
Treat for toxoplasmosis: \*Pyrimethamine and sulfadiazine for 2 weeks and repeat CT\*
90
What is PML?
Progressive Multifocal Leukoencephalopathy -In HIV pts -No ring enhancement -Tx is just to raise CD4 with HIV drugs
91
Presentation of neurocysticercosis:
Pt from Mexico with a seizure
92
What does head CT show in neurocysticercosis?
Multiple 1 cm cystic lesions Over time they will calcify
93
Tx of neurocysticercosis?
Albendazole if not yet calcified Anti-epileptic drugs if calcified
94
Who should receive stress ulcer prophylaxis? What do they get?
Give PPIs to pts with: -Head trauma -Burns -Endotracheal intubation with mechanical ventilation
95
Sxs of subarachnoid hemorrhage?
Thunderclap Stiff neck Photophobia LOC in 50% of pts Focal neuro deficits
96
How to diagnose a SAH?
Head CT If inconclusive, do LP
97
How to know if an increased WBC count in the CSF is from infection or just from blood?
Ratio of WBC:RBCs \*1:500 is normal\* \*\>1:500 signals infection\*
98
Tx of SAH?
1. Angiography to determine site of bleeding 2. Embolize bleeding site (superior to clipping) 3. Nimodipine to prevent stroke from vasospasm
99
What's the pathophysiology, causes, sxs, dx, and tx of syringomyelia?
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
Can cord compression from metastatic tumors cause pain and tenderness in the spine?
Yes
101
How does a spinal epidural abscess present?
Back pain + tenderness + fever
102
Tx of spinal epidural abscess?
Oxacillin/nafcillin
103
When is pain the worst with spinal stenosis?
LE pain when walking downhill
104
Dx and tx of spinal stenosis?
Dx: MRI Tx: Surgical decompression
105
Describe Brown-Seguard syndrome:
Loss of: -Ipsilateral motor fxn -Contralateral pain and temperature sense
106
Most urgent step in management of cord compression?
Steroids to relieve pressure on the cord
107
When is the diagnosis of cord compression clear?
Back pain + tenderness + hyperreflexia of the legs
108
Signs of ALS:
UMN: Hyperrflexia, Weakness, Spasticity LMN: Muscle wasting, fasciculations
109
Tx of ALS and how does it work?
Riluzole Blocks accumulation of glutamate
110
Radial nerve palsy results in \_\_\_\_
Wrist drop
111
Peroneal nerve palsy results in \_\_\_\_
Foot drop Loss of foot eversion
112
What can cause peroneal nerve palsy?
High boots pressing at the back of the knee
113
Sxs of Bell's Palsy:
Hemifacial paralysis Loss of taste on anterior 2/3rd of tongue (CN VII) Hyperacusis d/t loss of stapedius control (the shock absorber)
114
Tx of Bell's?
Steroids
115
What is reflex sympathetic dystrophy also known as?
Chronic regional pain syndrome
116
In whom does reflex sympathetic dystrophy (Chronic regional pain syndrome) effect?
Pts with previous injury to the extremity
117
Sxs of Chronic regional pain syndrome:
Extreme pain of burning quality upon light touch
118
Tx of chronic regional pain syndrome?
NSAIDs Gabapentin Occasionally nerve block
119
Tx of RLS?
Pramipexole or ropinirole (dopamine agonists)
120
Best initial test for myasthenia?
Anti-acetylcholine receptor antibodies
121
Best initial tx of myasthenia?
Pyridostigmine or neostigmine
122
What to do for myasthenic pts if initial meds don't work?
Thymectomy (if pt is
123
What to do if thymectomy doesn't work for myasthenic pts?
Prednisone
124
Sxs of myasthenia?
Weakness in muscles of mastication (can't finish meals) Blurry vision Diplopia Ptosis
125
What can be used for myasthenia in order to keep patients off of long-term steroids?
Azathioprine and cyclosporine
126
How do cyclosporine and azathioprine work?
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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