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Internal Med EOR > Neuro 3 > Flashcards

Neuro 3 Flashcards

1
Q

where are astrocytomas MC located

A

infratentorial in kids
supratenortial in adults

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2
Q

types of astrocytomas

A

pilocytic astrocytoma - grade 1 - most common in kids and young adults; most benign

diffuse astrocytoma - grade 2

anaplastic astrocytoma - grade 3 - rare but aggressive

grade 4 - glioblastoma multiforme in the MC CNS tumor in adults

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3
Q

sx astrocytoma

A

focal deficits MC - HA, may wake patients up at night, may be positional, cranial nerve deficits, AMS

increased intracranial pressure due to mass effect – HA, N/V, PAPILLEDEMIA, ATAXIA

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4
Q

dx astrocytoma

A

CT scan or MRI with contrast - grade I and II and non enhancing; grade 3 and 4 are enhancing

brain bx:
pilocytic - grade 1 - form sacs of fluid (cystic) Rosenthal fibers (eosinophilic corkscrew fibers)

diffuse astrocytoma - micro cysts and mucus like fluid

anaplastic - tentacle-like projections that grow into surrounding tissue

glioblastoma - may contain cystic material, calcium deposits, blood vessels; malignant astrocytes + necrotizing, hemorrhagic center surrounded by pseudo palisading (tumor cells lining area of necrosis)

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5
Q

tx astrocytoma

A

surgical excision

+ radiation for anaplastic and glioblastoma

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6
Q

brain MRI with contrast for glioblastoma

A

varian ring enhancement w central necrosis, surrounded by edema and irregular (serpiginous) margins

may cross the corpus callosum (butterfly glioma)

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7
Q

meningioma

A

usually benign, slow growing tumor arising from arachnoid meningothelial cells of meninges

most commonly arises from dura

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8
Q

MRI with contrast meningioma

A

intensely enhancing well defined lesions often attached to the dura (resembling a snow ball)

may have calcifications

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9
Q

histology meningioma

A

spindle cells concentrically arranged in a whorled pattern

psammoma bodies (concentric round calcifications)

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10
Q

tx meningioma

A

asx - observe if small

sx - surgical excision

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11
Q

CNS lymphoma

A

variant of extra nodal non-hodgkin lymphoma

diffuse large B cell lymphoma

epstein barr virus positive in 90%

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12
Q

CT scan or MRI contrast with CNS lymphoma

A

hypointense ring-enhancing lesion in deep white matter on CT

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13
Q

tx CNS lymphoma

A

methotrexate most effective chemo

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14
Q

ependymoma - in what population is it most common and where does it come from

A

MC in kids
most commonly arise from 4th ventricle, spinal cord, medulla

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15
Q

bx ependymoma

A

perivascular pseudo rosettes (tumor cells surrounding a blood vessel)

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16
Q

bx hemangioma

A

well defined borders
does not invade surrounding healthy tissue
foam cells with high vascularity

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17
Q

what is the MC type of dementia

A

alzheimer disease

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18
Q

pathophys alzheimer dz

A

extracellular amyloid beta protein deposition
neurofibrillary tanges (hyperphosphoslated tau proteins)
acetylcholine deficiency

19
Q

sx alzheimer dz

A

short term memory loss (first sx)
long-term memory loss and cognitive deficits

20
Q

dx alzheimer dz

A

clinical dx
MRI preferred - cortex atrophy (medial temporal lobe atrophy), reduced hippocampal volume, white matter lesions

21
Q

tx alzheimer dz

A

acetylcholinesterase inhibitors - Donepezil, Rivastigmine, Galantamine

NMDA antagonist - memantine

22
Q

most important RF for vascular dementia

A

HTN

23
Q

sx vascular dementia

A

sudden decline in fx w a stepwise progression of sx (infarct –> decline –> stable –> infarct –> decline)

cortical sx - may affect executive function, cause aphasia, hemineglect

motor deficits including urinary difficulties and gait abnormalities

24
Q

frontotemporal dementia is also called

A

pick’s disease

25
Q

histology for frontotemporal dementia

A

pick bodies - round or oval aggregates of tau protein

26
Q

sx frontotemporal dementia

A

marked changes in social behavior, personality, language (aphasia)

disinhibition or socially inappropriate behaviors
hyperorality
apathy

27
Q

what is diffuse Lewy body dz

and what proteins make up lewy bodies

A

progressive dementia characterized by diffuse presence of lewy bodies (alpha-synuclein proteins) in comparison to PD where Lewy bodies are localized

28
Q

sx diffuse Lewy body disease

A

recurrent visual hallucinations
cognitive fluctuations
Parkinsonism
autonomic dysfunction
dementia is a late finding

29
Q

focal seizure - include simple vs complex

A

abnormal neuronal discharge from one discrete section of one brain hemisphere

simple - retained awareness
complex - impaired awareness

30
Q

sx focal / partial seizure

A

focal sensory, motor, or autonomic sx depending on lobe affected

motor - jerky rhythmic movements

Jacksonian march - start in one area and spread to other aparts

Todd’s paralysis - followed by a Neurologic deficit lasting up to 24h

< 3 min

automatisms - repetitive behaviors

post ictal phase - somnolence, HA, confusion

31
Q

when is absence / petit Mal seizures MC seen

A

childhood 4-10 years

32
Q

sx absence (petit mal)

A

pause/stare - sudden marked impairment of consciousness and low of awareness without loss of body tone

bank staring episodes with unresponsiveness

5-10 s

eyelid twitching and automatisms

33
Q

dx absence / petit mal

A

EEG - b/l synchronous and symmetrical 3 hz (3 cycles per second) spike and wave discharges

34
Q

tx absence / petit mal

A

ethosuximide - first line
valproic acid - second line

35
Q

what is a generalized seizure

A

simultaneous neuronal discharge of both hemispheres (diffuse brain involvement)

36
Q

tonic clonic (grand mal)

A

sudden LOC with tonic activity (contraction and rigidity) followed by 1-2 minutes of clonic activity (repetitive, rhythmic, symmetric jerking < 3 min)

post-ictal confusion phase

37
Q

clonic

A

repetitive rhythmic jerking associated w post-ictal

38
Q

myoclonic

A

involuntary twitching of one muscle or a group of muscles without LOC

39
Q

tonic

A

LOC + rigidity

40
Q

atonic

A

drop attack

41
Q

what is decreased immediately after seizures and helps to rule out pseudo seizures

A

prolactin
lactic acid

42
Q

what is status epilepticus

A

single continuous epileptic seizure lasting 5 min or greater or > 1 seizure within 5 min period without recovery

43
Q

tx status epilepticus

A

benzos are preferred initial (lorazepam)

44
Q
A

Internal Med EOR (17 decks)

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