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Flashcards in Neuro Deck (162):
1

primary vs secondary HA

primary HAs are recurrent and benign. Secondary is new onset and life threatening

2

What HA is frequency and bilateral and most common HA

tension HA

3

What HA is unilateral, aura, recurrent, associated with periods.

migraine

4

You are thinking migraine, but you find focal neurological findings, what must be ruled out?

stroke

5

patient can't stay still, male patient, horrible pain, tearing, sweating, ptosis and miosis, all symptoms are unilateral, what type of HA

Cluster

6

thunder clamp HA

subarachnoid

7

tx for HA

dopamine agonist (

8

route to giving medications for HA

IV is faster than IM, IM is faster than oral

9

treat for HA

O2(higher concentration the better) or intranasal lidocaine

10

HA preventions

Antidepressants, anticonvulsants, Antihypertensives

11

Ischemic stroke is what color on CT

black

12

hemorrhagic stroke is what color on CT

white

13

What type of stroke is known for headache?

hemorrhagic

14

sudden onset of L arm, what artery

right side middle cerebral artery

15

sudden onset of L leg, what artery

right side anterior cerebral artery

16

treatment for hemorrhagic stroke

ABC, lower BP, reverse anticoagulopathy, Lower ICP.

17

how do you lower ICP with hemorrhagic stroke

mannitol, hyperventilation, burr hole

18

ischemic stroke management

ABC, Fibrinolysis (break up clots), Lower ICP

19

general stroke management (ischemic)

head of bed at 30 degrees, NPO, bed rails up, ASA, (allow BP to be a little high in ischemic stroke), no hypotonic fluids, control fever, control blood sugar, stop from getting blood clots.

20

what are the five Ds of a posterior stroke?

Dizziness (vertigo)
- Diplopia
- Dysarthria
- Dysphagia
- Dysmetria

21

one side of the face and the opposite side of the body if affects. where is the stroke?

posterior circulation / vertebral/basilar system

22

A patient presents with the ability to produce fluent speech, though the words and sentence structures do not make sense. In which of the following areas of the brain is the defect occurring?

Wernicke’s aphasia (’Receptive aphasia’) occurs when the area of the brain that organizes speech is affected. The patient retains the ability to produce speech, but is unable to organize it into comprehensive language.

23

patient presents with loss of the left visual field in each eye. What is the most likely location for the lesion

Lesions in the right optic tract will cause a left homonymous hemianopsia.

24

most common cause of subarachnoid hemorrhage

aneurysm due to HTN

25

worse/different headache of life, presented with syncope

subarachnoid hemorrhage

26

get a sentinel headache (initial) than get better

subarachnoid hemorrhage

27

how do you dx subarachnoid hemorrhage

CT (if negative use LP there will be blood) if either is positive =surgery

28

what level of spine is LP done

L2 (b/c cord ends)

29

xanthochromia

bright red blood cells in CF, positive for subarachnoid hemorrhage

30

tx of subarachnoid hemorrhage

control: pain, bp, reverse blood thinners, control seizures. Bleed blocks CF drainage can cause hydrocephalus

31

best study to see damage of TIA

advanced imagining

32

tx for TIA

aspirin, carotid endarterectomy (>70% blockage), anticoagulant

33

patient has TIA, look at what PE finding

carotid bruit and a fib on ECHO

34

what is Bell's Palsy? what nerve

unilateral facial palsy without other symptoms, CN VII.

35

what causes Guillian Barre

immunizations (flu vaccine) GI illness (camptobacyter)

36

cannot wrinkle forehead is this bell's palsy or stroke

bell's palsy (cannot close eye, wrinke forehead, ear pain before palsy, lacrimation)

37

tx of bell's

acyclovir and steroids

38

DM neuropathy

is symmetrical weakness in lower legs

39

symmetric bilateral lower extremity weakness that is ascending 2-4 weeks after benign illness, then progressive, symmetric, distal to proximal lower extremity weakness over 2 weeks


Guillian Barre

40

worse complication of Guillian Barre

diagram weakness and Autonomic: cardiac, urinary retention

41

LP on Guillian Barre will show

elevated protein

42

tx for Guillian Barre

plasmapheresis and IV immunoglobin

43

myasthia gravis hallmark

improves with rest and ptosis gets worse throughout the day, worry about diaghramic weakness

44

dx of myasthia gravis

edrophonium test

45

you suspect myasthenia gravis, what must be ruled out and how

thymona on chest xray

46

anti acetylcholine receptor test antibodies

is positive in 90% of myasthenia gravis patient

47

tx of myasthia gravis

cholinesterase inhibitors (pyridostigmine), corticosteroids,
immunosuppressive agents, IVIG, plasmapheresis

48

what is Lambert-Eaton?

uncommon disorder of neuromuscular junction
transmission with the primary clinical manifestation of PROXIMAL muscle weakness. defective release of acetylcholine


49

what cancer is Lambert-Eaton associated with

small cell

50

proximal muscle power increases with sustained contraction as day goes on

Lambert-Eaton

51

Dx of Lambert-Eaton

Dx: electrophysiologic studies

52

tx of lambert eaton

Tx: plasmapheresis, immunosuppressive therapy, tumor treatment

53

pregnancy ladies get what type of meningitis

listeria

54

Neonates get meningitis from

Group B Strep., E. coli, Listeria

55

2 months to 6 years get what type of meningitis

2 months to 6 years: Strep pneumonia, H. flu Type B, Neisseria
meningitidis

56

greater than 6 including adults get what type of meningitis

Greater than 6 years: Strep pneumonia, Neisseria meningitidis

57

Brudzinski’s sign:

flexion of knees with flexion of the head

58

Kernig’s sign:

head flexion when the knees are flexed and then the leg is extended
○ Mnemonic: K = Knees

59

dx meningitides, must get what before LP

get CT scan

60

findings in LP with bacteria meningitis

low sugar

61

tx of meningitis for age Less than 8 wks age

Ampicillin + Cefotaxime (or Aminoglycoside)

62

antibiotic used for listeria

Ampicillin

63

Greater than 3 mo (and adults) tx for meningitis

Ceftriaxone + Vancomycin

64

treatment Immunocompromise/Chronic EtOH/>50 yrs with meningitis

Ampicillin + Ceftriaxone + Vancomycin

65

Head trauma/VP shunt/CNS surgery: tx for meningitis

Vancomycin + Ceftazadime

66

decreases deafness related to H. flu

Dexamethasone

67

admit bacteria or viral meningitis

bacteria

68

treat close contact if patient is treated with meningitis with?

Ciprofloxacin, Rifampin, Ceftriaxone

69

Waterhouse-Friderichsen syndrome

complication of adrenal failure due to meningitis

70

prevention of meningitis

Haemophilus influenzae type b (Hib)
Pneumococcal conjugate vaccine (PCV7)
Pneumonococcal polysaccharide vaccine (PPSV)
Meningococcal conjugate vaccine (MCV4)

71

encephalitis is.......
viral or bacterial

Infection of brain parenchyma causing destruction of neurons, Usually caused by viruses
○ HSV1, HSV2, Varicella, Equine, West Nile, HIV, Measles, Rabies

72

dx encephalitis

CT head, Lumbar puncture: Viral and bacterial cultures, antigen tests, MRI: classic temporal lobe pattern
Brain Biopsy

73

tx of encephalitis

Antiviral medications: e.g., acyclovir, foscarnet
Empiric antibiotics for bacterial meningitis
● Antiepileptics
● Steroids: e.g., dexamethasone
● Supportive care (these are sick people!)

74

do encephalitis need to be admitted

YES, ICU

75

bacterial LP

glucose low, elevated pressure and high protein

76

viral LP

Lymphocytes (everything else is normal)

77

TB LP

high protein

78

encephalitis LP

normal pressure, normal glucose and protein

79

ring enhanced lesion with focal neurologic finding

brain abscess

80

things that cause brain abscess

Usually bacterial, can be fungal
● Direct spread: Sinus infection, ear infection
● Emboli: Endocarditis, cyanotic congenital heart disease
● Treatment: long term antibiotics and surgical drainage

81

parkinsons is the loss of

dopaminergic neurons

82

treatment of parkinson's

Levodopa (supplement dopamine) plus carbidopa (stops breakdown of levodopa)
○ Side effects: dyskinesias
● MAO-B inhibitors: well tolerate
Anticholinergics
deep brain stimulator

83

Myasthenia Gravis associated with

associated with thymus tumor → thymoma

84

signs and symptoms of MG

Proximal weakness – repeated movements (brushing hair)
● Fatigue
● Ptosis, Diplopia
● Dropping head

85

dx of MG

“Tensilon test” (edrophonium), stops breakdown of Ach, pt will have increased strength

86

other physical and lab test that help dx MG

Fatigability test: continued upward gaze leads to ptosis, relieved with rest
● “Ice pack test” ptosis should improve with cold
● Antibodies to Ach receptors
● “Tensilon test” (edrophonium), stops breakdown of Ach

87

what disorder is similar to MG but no weakness and patient has lung cancer

Lambert Eaton

88

treatment of MG

Acetylcholinesterase inhibitors: neostigmine, pyridostigmine
● Immunosuppressants: prednisone, azothioprine
● IgG plasmapharesis
● Thymectomy → can improve even without thymoma

89

huntington's disease is genetic auto dominant or recessive

dominant 50% of offspring get it!

90

what is Huntington's dz

Degeneration and loss of neurons with atrophy in caudate nucleus/putamen

91

symptoms of huntington's dz

Psychosis usually predominates
○ Antisocial/poor impulse control
movement disorder and dementia

92

tx of huntingston's

Tetrabenzanine: depletes monoamines and antidepressants and antipsychotics

93

categories of of Glascow coma

motor, verbal, eye opening

94

highest GC score and lowest

15 and 3

95

presentation of 2 types of Brainstem hemorrhage
pontine and cerebellar

Pontine: pinpoint pupils
Cerebellar: extensor posturing, lost papillary reflex

96

Herniation syndromes
two types uncial herniation and central herniation(this is worse)

Uncal herniation: dilated, non-reactive ipsilateral pupil
○ Central herniation: loss of brain stem reflexes, decorticate posturing and irregular respirations

97

Pseudocoma test

Nystagmus with caloric vestibular testing (freezing cold water in pt's ear)

98

Consider ICP protection with

mannitol or hypertonic saline

99

types of delirium

Hyperactive: withdrawal or intoxication (EtOH, drugs)
● Hypoactive: Hepatic encephalopathy, hypercapnia
● Mixed: Daytime sedation, nocturnal agitation

100

visual hallucinations, must rule out

acute delirium

101

medications that can help or exacerbate delirium

Rivastigmine, haldol, ativan, propofol

102

Vascular dementia dffers from other dementia by...

gait or deep tendon reflex abnormalities

103

Changes in tau protein → causes neurofibrillary tangles, senile plaques and atrophy is what disorder?

Alzheimer’s Disease

104

Alzheimer’s Disease risk factors

age, Down’s syndrome, family history, HTN, insulin resistance, obesity

105

autoimmune antibodies → inflammatory demyelinating polyneuropathy → delayed nerve conduction → symmetric ascending weakness paralysis

Guillian Barre

106

hallmark of Guillian Barre syndrome

Poor to absent reflexes

107

Lumbar Puncture shows Elevated protein > 400mg/dL in 90%, ascending weakness and decreased nerve conduction studies or muscle biopsy.

Guillian Barre.
Dx Gold standard is nerve conduction and muscle biospy

108

treatment of autonomic symptoms of guillian barre

Treat autonomic symptoms
○ Bradycardia → atropine
○ Hypertension → nitroprusside or beta blocker
○ Hypotension → IVF
○ Heart block → temporary pacing

109

medical treatment of GB (guillian barre)

IVIG or plasma exchange proven to shorten recovery by 50% but Steroids alone do not work

110

MS is know for migratory and chronic symptoms name some of the migratory symptoms

Sensory loss
Cerebellar sx (dysarthria, ataxia, tremor) Heat intolerance
Motor spinal cord sx
Optic neuritis, Muscle spasticity,
Lateral gaze diplopia
Bladder dysfunction, constipation

111

Optic neuritis with MS

painful vision loss, color perception is altered, disc looks normal, usually unilateral, flashes of light (phosphrenes)
retrobulbar pain

112

dx of MS

McDonald Criteria :Clinical scoring system + MRI + CSF
Lumbar Puncture :Oligoclonal band pattern on electrophoresis
● MRI
○ Atrophy and “black holes” signify axonal death

113

tx for acute exacerbation of MS

steroids

114

chronic treatment for MS

Interferon, immunosuppressives

115

symptom control MS

Symptom control
○ amantadine (fatigue), baclofen (spasticity), Aricept

116

Dx for MG

Anti-AChR antibody positive in 75%, Antistriated muscle Ab
Anti muscle-specific receptor tyrosine kinase

117

MG is associated with?

Associated w/ autoimmune dx (commonly hypothyroid) and thymoma

118

Proximal, symmetric muscle weakness >> distal
Upper extremity >> Lower extremity
Progresses downward over weeks to months
Normal sensory exam and deep tendon reflexes

MG

119

Epilepsy defined by

2 unprovoked seizures at least 24 hours apart

120

Absence seizures medication

ethosuximide

121

Tonic, atonic, myoclonic or generalized tonic-clonic medications

○ valproate, lamotrigine, topiramate

122

Partial seizure medications

○ carbamazepine, lamotrigine

123

Status Epilepticus

any type of prolonged seizure (>30mins) start treatment within 10 mins

124

treatment for status epileptics- ongoing seizure

1st line :lorazepam, diazepam, usually try 3 doses
● 2nd line: fosphenytoin or phenytoin
○ if seizures continues x 20min then Phenobarbital
● 3rd line :midazolam drip, proposal, pentobarbital coma
● Treat fever electrolytes or withdrawal

125

what is PANAS

Post-strep autoimmune neuropsychiatric disorder
● Clusters of patients who develop tics
○ Higher incidence of recent strep in new tics

126

recovery plan for concussions

24 hr asymptomatic then return in increasing activity

127

post concussion syndrome dx after symptoms last more than

3 months

128

anti epileptic drug avoided in pregnancy

valproate acid should be AVOIDED because of higher trends noted of congenital malformations.

129

cerebral palsy must to dx before what age?

3 (it is non-progressive)

130

facts about cerebral palsy

brain lesions and #1 cause of child disability (premature babies)

131

hypotonic--spasity ---contractures and missed milestones

CP

132

tx CP

botox, antidepressants, tendon release, parkinson's drugs

133

Locked-in-syndrome is classically caused by injury to which portion of the brain

bilateral brainstem. pt can still blink their eyes

134

simple seizure is described as

focal neuro deficits with preserved consciousness

135

complex seizure is described as

Confusion and bizarre behavior

136

why is the vasodilator nimodipine given when a Subarachnoid hemorrhage is dx?

Clinically significant vasospasm complicates 20-30 percent of aneurysmal subarachnoid hemorrhage, and nimodipine has been shown to improve neurologic outcomes. Treatment is started within the first 4 days post-SAH and is continued for 21 days.

137

diagnosis of Narcolepsy

Multiple sleep latency test

138

An MRI with gadolinium contrast is the study of choice for suspected ________. Periventricular plaques is considered the classic finding for ______________

MS

139

Complex seizures are most often found when the ____ lobe is affected.

temporal lobe

140

most common skull fracture

linear

141

Charcot-Marie-Tooth is an inherited demyelinating polyneuropathy most commonly seen during what period of life?

1st and 2nd

142

the most important initial steps after establishing an IV and placing the patient on a monitor for altered mental status?

Blood glucose testing

143

A 23 year old female present to the emergency room complaining of the ‘worst headache of her life’ for the past 3 hours. She tried ibuprofen without relief. She denies nausea or vomiting, and vision changes. A head CT reveals no apparent abnormalities. A lumbar puncture is performed and the CSF analyzed. Which of the following findings would confirm your suspected diagnosis?

must think subarchnoid hemorrhage with worst HA of life.
LP with show RBC (erythrocytes)

144

A 34 year old male presents to the clinic complaining of feeling emotionally unstable, and having frequent headaches. He also states that he has noticed a resting tremor that improves with purposeful actions, and some stiffness or rigidity to his movement. These symptoms have gradually worsened over the last few months. Examination of the eyes is remarkable for dark rings that appear to encircle each iris. Which of the following tests, if abnormal, confirms this patient's likely underlying condition?

parkinson like symptoms-in a young person, should prompt the dx of Wilson dz.
Serum ceruloplasmin, a copper binding protein, levels are typically reduced in these patients. If this test is positive, or you have a high clinical suspicion of the disease, a 24-hour urine copper test (with elevated levels) and a slit lamp exam for Kayser-Fleischer rings should also be performed. Kayser-Fleischer rings are the pathognomonic sign of Wilson’s Disease

145

huntington's dz presents between what ages

This condition is inherited in an autosomal dominant fashion, and symptoms usually begin to be manifest between the ages of 30-50

146

Which of the following results is most helpful in diagnosing a Subarachnoid hemorrhage?

In SAH, the bleeding occurs into the space that is occupied by the CSF. Thus, RBC’s in the CSF is the most helpful of the options listed in making this diagnosis. ~95% of cases will show an abnormality on CT scan.

147

jacksonian march is associated with which type of seizure?

‘Jacksonian March’ is due to discharges in the sensorimotor cortex causing rhythmic jerky movements that spread throughout the entire side of the body. This classic finding is most often associated with simple seizures.

148

best imagining for CP

MRI is the preferred imaging test in diagnosing CP.

149

bilaterally intranuclear ophthalmoplegia is associated with?

intranuclear ophthalmoplegia is paresis of the medial rectus muscle (slowness or loss of adduction) and when bilateral in nature, especially in a younger patient, is most likely caused by Multiple Sclerosis.

150

What cluster of features make up Cushing's Triad and indicate increased intracranial pressure?

Hypertension, bradycardia, respiratory depression

151

58 year old male presents to the emergency department with a temperature of 103.1 F ( 39.5 C), a headache and has had persistent vomiting over the course of the last two hours, and his wife reports what sounds like seizure activity. He is currently showing signs of altered mental status, has a positive Kernig sign. What is the most appropriate next step in the management of this patient?

vancomycin plus ampicillin, plus cefotaxime. Dexamethasone may be added to improve meningeal penetration and decrease morbidity. CT head should then be pursued to determine presence or absence of space-occupying lesions, prior to the lumbar puncture.

152

Which of the following is most effective as a primary monotherapy used to treat Partial seizures?

Carbamazepine is considered to be a first-line monotherapy drug effective in treating partial seizures with or without secondary generalization.

153

What is the drug of choice in treating patients with Myasthenia Gravis?

Pyridostigmine

154

Crescent shape tracking along brain is seen is what head bled?

subdural

155

Patients suffering from Multiple Sclerosis tend to exhibit a variety of symptoms. Which of the following medications is used in the treatment of spasticity associated with this disease?

baclofen

156

Which of the following is the most common artery involved in epidural hematoma?

The middle meningeal artery is involved in more than 75% of cases of epidural hematoma. Its course carries it over the lateral side of the head, and its superficial location predisposes it to injury.

157

What is the diagnostic test of choice for bronchiectasis?

High resolution chest CT showing dilated tortuous airways is diagnostic of bronchiectasis.

158

The CT scan reveals blood vessels leading to nodules within the lung, and he has a positive ANCA test, but otherwise labs are non-contributory.

Wegener’s Granulomatosis

159

what is the workup for Diagnose new effusion in toxic-appearing patient
Suspected parapneumonic effusions (including patients with previously diagnosed effusions)


Thoracocentesis with analysis

160

"ongoing or intermittent seizure activity without convulsions for at least 30 minutes, without recovery of consciousness between attacks."

Non-convulsive status epilepticus

161

is Flexion teardrop fracture an unstable cervical spine injury?

yes

162

Trigeminal neuralgia, or tic douloureax, has been found to respond well to

carbamazepine.