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Flashcards in Neuro Deck (128):
1

PC:
- CONTRA weakness or sensory loss
- homonymous hemianopsia-- looking towards side of lesion
- aphasia

MCA

2

if you are right handed...

L dominant lobe
- handedness
- speech center

3

PC:
- personality and confusion
- urinary incontinence
- legs> arms

ACA

4

PC:
- IPSI sensory loss face, 9th, 10th CNs
- CONTRA sensory loss limbs
- limb ataxia

PCA

5

best initial test for stroke

non-contrast CT

6

diagnostic tests for stroke

1. ECHO- PFO, surgical valve, thrombus
2. EKG
3. Holter
4. carotid doppler-- degree of stenosis

7

tx for haemorrhagic stroke

NO TX

8

tx for ischaemic stroke less than 3hrs

thrombolytics

9

tx for ischaemic stroke greater than 3hrs

aspirin

10

tx for ischaemic stroke greater than 3hrs and already on aspirin

ADD dipyridamole
or SWITCH to clopidogrel

11

additional tx to add in for stroke

statins!

12

experimental window for thrombolytics

3-4.5hrs

13

carotid angioplasty and stenting

NOOOOOOO proven benefit
ALWAYS the wrong answer

14

% carotid stenosis and tx

less than 50%= no tx
greater than 70%= endarterectomy

15

PC pseudotumor cerebri

RICP and CN 6 palsy

16

risk factors for pseudotumor cerebri

- obese young female
- venous thrombosis
- OCP
- vit A excess

17

dx for pseudotumor cerebri

LP increase pressure

18

tx for pseudotumor cerebri

1. weight loss
2. acetazolamide

19

tx for cluster headaches

- triptans
- octreotide
- ergotamine
- 100% oxygen, lithium, prednisone= ABORTIVE, not for mgiraines

20

cluster prophylaxis

verapamil
prednisone
valproate

21

best preventitive tx for migraines-- if 3 attacks/month

propanolol
valproate

22

tx trigeminal neuroalgia

oxcarbazepine or carbamezapine

23

trigeminal neuralgia that doesn't improve with medication

gamma knife surgery

24

postherpetic neuralgia pain tx

- TCA's
- gabapentin
- pregabalin
- carbamezapine
- phenytoin
- topical capsaicin

25

reduce incidence of postherpatic neurlagia

antiherpetic medications

26

clearly effective treatment for peripheral neuropathy?

NOOOPE

27

when to do EEG

when tried to exclude all the causes
including CT or MRI

28

seizures of unclear etiology=

EPILEPSY

29

treatment for status epileptics

1. benzodiazepine
2. fosphenytoin> phenytoin
3. phenobarbital
4. GA

30

an unresolving seizure tx

NEUROMUSCULAR BLOCKING AGENTS
- succinylcholine
- vecuronium
- pancuronium

31

what to give before propofol

ventilator-- since propofol can stop breathing

32

when to give anti epileptic drugs after first seizure-- few circumstances

1. PC= SE or focal neuro signs
2. abnormal EEG or lesion on CT
3. fam hx of seizures

33

best tx for epilepsy

NOT CLEAR

34

which anti epileptic has the fewest side effects

leviracetam (!!! SJS)

35

best tx for absence seizures

ethosuximide

36

alcohol withdrawal seizures tx

NOT NOT NOT NOT NOT with anti epileptic drugs

37

when to stop anti epileptic meds

2 years seizures free

38

how to check for possibility of seizure recurrence

sleep deprivation EEG

39

patient with epilepsy, and driving....

recommend find an alternate means of transportation

40

SAH vs. meningitis

SAH
- more SUDDEN onset
- LOC

41

best initial test for SAH

non-contrast CT

42

most accurate test for SAH

LP-- xanthochromia

43

WBC: RBC ratio normal

1: 500
normal= SAH
abnormal= meningitis

44

why don't you use contrast for bleeds in brain?

BECAUSE BLOOD= WHITE

45

mortality rate if have recurrence of SAH

50-70%

46

tx of SAH

1. nimodipine
2. embolization (coiling)> clipping
3. VP shunt IF hydrocephalus
4. seizure prophylaxis

47

seizure prophylaxis for SAH

PHENYTOIN

48

if embolization is not one of the choices...

surgical clipping

49

embolization for SAH is a type of

INTERVENTIONAL RADIAOLOGY

50

LOSS of all spinal functions, except position and vibration
LOSS DTR's--> hyperreflexia

anterior spinal cord syndrome

51

LOSS of contralateral pain and temp
LOSS of ipsilateral vibration and position

brown sequard

52

loss of sphincter tone and acute weakness/ sensation loss

spinal trauma

53

tx spinal trauma

glucocorticoids

54

LOSS of pain and temperature cape like

syringomyelia

55

big syringomyelia

LOSS of lateral corticospinal= LMN

56

BIGGEST syringomyelia

LOSS of hypothalamospinal= PAM

57

most accurate dx of syringomyelia

MRI

58

tx syringomyelia

- sx: tumor
- drainage fluid

59

moa brain abscess

CONTINGUOUS-- sinusitis, mastoiditis or
BSI-- anything that causes BSI-- pneumonia, endocarditis

60

best initial test for brain abscess

CT or MRI

61

most accurate test for brain abscess

BIOPSY-- determine organism

62

CSF for brain abscess

not helpful

63

LP for brain abscess

NOOOO contraindicated

64

edema and contrast enhancement on CT

- tumor
- infection

CANNOT TELL THE DIFFERENCE

65

empiric tx brain abscess

penicillin + metro + ceftriaxone (or cefepime)

66

intention and exertion tremor

BET

67

BET improves with

alcohol

68

BET tx

propanolol

69

MCC parkinsonism

idiopathic

70

mild parkinson disease tx

- anticholinergics
- amantadine

71

anticholinergics in PD

- benztropine
- trihexyphenidyl

Tremor and Rigidity

72

older patient intolerant of anticholinergics for PD

AMANTADINE

73

severe parkinson disease tx

- dopamine agonists
- L-dopa/carbidopa
- COMT inhibitors
- MAO inhibirotrs
- deep brain stimulation

74

dopamine agonists for PD

BEST INITIAL tx

75

L-dopa/carbidopa for PD

most effective
ON/OFF

76

COMT inhibitors for PD

extend duration of L-dopa/Carbidopa by blocking the metabolism of dopamine

77

MAO inhibitors for PD

single or adjunct
block metabolism of dopamine
POSSIBLY SLOW the progression

78

deep brain stimulation for PD

Tremor and Rigidity

79

only PD med that possibly slows the progression

MAO inhibitors

80

severe PD presenting with psychosis

tx= antipsychotics
psychosis is secondary to the PD treatment

81

parkinsonism + orthostasis

Shy Drager syndrome

82

tx spasticity

- baclofen
- dantrolene
- TIZANADINE

83

RLS a/w

fe deficiency anaemia

84

RLA tx

dopamine agonist
- pramipexole

85

3M's of huntingtons

Mood
Movement
Memory

86

dx HD

GENETIC TEST

87

tx dyskinesia in HD

tetrabenazine

88

psychosis tx in HD

- haloperidol
- quetiapine

89

imaging HD

CT/MRI-- caudate nucleus involvement

90

sexual function MS

generally intact

91

best initial test MS

MRI

92

most accurate test MS

MRI

93

oligoclonal bands MS

only found in 85%;
correct answer if equivocal or non diagnostic MRI

94

visual and auditory evoked potentials for MS

WRONG WRONG WRONG WRONG WRONG ANSWER

95

steroids in MS

shorten duration of exacrerbation

96

natalizumab

alpha 4 integrin inhibitor
---> PML

97

best initial MS relapse prevention meds

- beta interferon
- glatiramer

98

poor prognosis ALS

weak cough and swallowing

99

dx of ALS

electromyography

100

riluzole ALS

reduced glutamate buildup in neurons
MAY prevent progression of disease

101

tx ALS spasticity

baclofen

102

other tx for ALS

- CPAP
- BiPAP
- tracheostomy and maintenance ventilator
since MCC death= resp failure

103

CMT=

UMN + LMN + PES CAVUS

104

mcc peripheral neuropathy

diabetes

105

peripheral diabetic neuropathy young

TCAs

106

peripheral diabetic neuropathy older

pregabalin
gabapentin

107

risk factors for lateral cutaneous nerve of thigh

- obesity
- pregnancy
- sitting with crossed legs

108

worsening pain with waling, pain/numbness in ankle and sole of foot

TIBIAL NERVE--> tarsal tunnel syndrome

109

random risk factor for peroneal palsy

HIGH BOOTS

110

two additional things for facial nerve palsy

- hyperaccusis
- taste disturbances

111

dx test for facial nerve palsy

NO TEST

112

complication of facial nerve palsy

CORNEAL ULCERATION

113

what nerves does GBS affect

peripheral nerves

114

most specific test for GBS

nerve conduction studies/ electromyography

115

CSF in GBS

INCREASED protein with
normal cell count

116

treatment of GBS

- IVIG
or
- plasmapharesis

117

wrong answers for tx of GBS

prednisone
plasmapharesis AND IVIG

118

LFT's GBS

DECREASE- FVC
DECREASE- peak inspiratory pressure

119

pupils in mg

NORMAL

120

best initial test for MG

- AChR antibodies; if without--> anti-MUSK

121

other test for MG, NOT done anymore in canada

edrophonium test

122

most accurate test for MG

electromyography-- decreased strength with repetitive stimulation

123

imaging for MG

CHEST- CT with contrast OR MRI
---> thymoma

124

best initial tx MG

neostigmine or pyridostigmine

125

if tx fails in MG

T CELL SUPPRESSION
- less than 60--> thymectomy
- greater than 60--> prednisone, then imunosuppresants

126

acute myasthenia crisis tx

- IVIG OR
plasmaphresis

127

diffuse symmetrical atrophy on MRI

- AZD
- chronic alcoholism
- untx HIV

128

CSF findings for CJD

14-3-3 protein