Neuro and optho from Step Up Flashcards
1
Q
ALS affects what tracts
A
corticospinal tract and ventral horn
2
Q
poliomyeltisis affects what tracts
A
ventral horn causing flaccid paralysis
3
Q
tertiary syphilis or tabes dorsalis affects what tracts
A
dorsal columns impairing proprioception and pain
4
Q
what is spinal artery syndrome
A
bilateral loss of pain and temp below lesion and bilateral spastic paresis below with flaccid paralysis at the level
5
Q
whats affected in spinal artery syndrome
A
corticospinal track, spinothalamic tract, ventral horn, lateral gray matter
6
Q
What tracts does Vit B12 deficieny affect
A
dorsal columns and corticospinal tract leading to bilateral loss of vibration and discrimination with bilateral spastic paresis affecting legs before arms
7
Q
what tracts are affected in syringomyelia
A
ventral horn and ventral white commissure
8
Q
Signs of syringomyelia
A
bilateral loss of pain and temp below and flaccid at the level
9
Q
what is brown sequard syndrome
A
ispi loss vibration and discrimination blow. ipsi spastic paresis below
ipsi flaccid paralysis at level
contra loss pain and temp below
10
Q
what tracts are affected in brown sequard syndrome
A
all tracts on one side of the cord
11
Q
Brudzinski
A
neck flexion in supine causes hip flexion
12
Q
What rash is seen in N meningitis
A
petechiae
13
Q
Tx meningtitis bacterial
A
cephalosporins usually 3rd gen
close contacts given rifampin or cipro for porphylaxis
14
Q
what are signs of incrreased intracranial P
A
papilledema, focal neurologic deficits, pupil asymmetry
15
Q
why no do LP if signs of intracranial P
A
increased risk of uncal herniation
16
Q
Tx fungal meningitis
A
amphotericin B
17
Q
Tx TB meningitis
A
RIPE
18
Q
most common cause meningitis in newborn
A
Group B strep
19
Q
common meningitis in 1 mo-2 year
A
strep pneumo and N meningitis
20
Q
common cause meningitis 2-18 year
A
N meningitis
21
Q
cause meningitis in 18-60+ y.o
A
S pneumo
22
Q
CSF bacterial meningitis
A
increased PMNs
increased pressure
decrease glucose
increase protein
23
Q
CSF in viral meningitis
A
increased lymphocytes
increased pressure
normal glucose
normal protein
24
Q
Malaise, HA, comiting, neck pain, dec consciousness and change in mental status with focal neurologic deficitis
A
encephalitis
25
encephalitis due to mumps, sign
partodi swelling
26
West nile virus encephalitis Presentation
flaccid paralysis with maculopapular rash
27
LPs in encephalitis
increased WBCs and normal glucose
28
Tx encephalitis
maintain ICP, supportive care
29
What medication can cause encephalitis in children
Aspirin during viral illness- reyes
30
Radiology sign of brain abscess
ring enhancing lesion
31
Tx brain abscess
empiric until Bx back and surgical drainage
32
labs for poliomyelitis
polio specific Ab
33
What happens with rhabdovirus (rabies)
severe encephalitis with neuronal degeneration and inflammation
34
fear of water ingestion
rabies from laryngeal spasm
35
foaming at mouth
rabies
36
what you would see on Bx of rabies
negri bodies, round eosinophilic inclusions in neurons
37
Tx trigeminal neuralgia
carbamazepine, baclofen, phenytoin, gabapentin, valproate, clonazepam, other anticonvulsants
38
most common adult HA
tension
39
pain characteristic of migrain
unilateral and throbbing
40
which HA can cause periorbital pain and horners
cluster
41
Sx of tension HA
bilateral tightness, occipital or neck pain
42
what helps with cluster HA
100%O2 ergots and sumatriptan
43
Tx migraines
NSAID, ergots, sumatriptan, IV antiemetics, proph of TCA, beta blockers, CCBs
44
harsh systolic murmur
aortic stenosis
45
when to do carotid endarterectomy
>60% males with no Sx
>50% in Sx males
>70% in Sx women
46
most common artery involved in embolic ischemic strok
middle cerebral a
47
if losing sensation to legs feet and toes, strok affected what a
anterior cerebral
48
lacunar a infarct cause
focal motor or sensory deficits loss coordination and difficulty speaking
49
basilar a infarct cause
CN abnormalities, contra full body weakness and decreased sensation, vertigo, loss coordination, difficulty speaking and visual abnormalities
may cause coma
50
imagin for suspected stroke
CT without contrast
51
Tx stroke
thrombolytic if within 3 hours of onset and no contraindications
52
What should you give to prevent additional strokes
antiplatelet Tx
53
Acute Tx hemorrhagic stroke
reverse anticoagulation, control BP monitor ICP with mannitol, hyperventilation and anesthesia
54
patient with stroke and high BP
do NOT Tx BP because need to maintain cerebral perfusion
55
What can cause parenchymal hemorrhage
HTN, AV malformation, brian aneurysm, stimulant abuse
56
Berry aneurysms are associated with what
ADPKD and ehlers danlos
57
LP in subarachnoid hemorrhage
RBC, xanthochromia and increased P
58
If SAH is suspected but negative CT
do LP
59
declining RBC count over successive collection tubes
traumatic LP
60
convex hyperdensity compressing brain
epidural
61
what artery is common cause epidural hematoma
middle meningeal
62
which hematoma can appear to cross midline
epidural
63
lens shape hematoma
epidural
64
what causes subarachnoid hemorrhages
rupture vessels between pia and arachnoid layers
65
what causes subdural hematoma
ruptured bridging veins after trauma between arachnoid and dura
66
signs subdural hematoma
slowly progressive HA and change in mental status, contra hemiparesis, increased DTRs
67
concave hyperdensity on CT
subdural hematoma
68
what is hurt in brocas aphasia
frontal gyrus
69
what is hurt in wernickes
posterior superior temporal gyrus
70
what is conduction aphasia
fluent speech, word substitutions, attempts to correct words, word finding pauses
71
what is global aphasia
nonfluent speech, poor comprehension, limb ataxia and difficulty producing words
72
meaningless phrases with poor comprehension
wernickes
73
generalized vs partial seizures
generalized involve entire cortex and partial is focal
74
what can cause status epilepticus
withdrawal anticonvulsants, alcohol withdrawal, trauma, preexisting seizure disorder, metabolic abnormalities
>20 minutes
75
which seizure has no LOC
simple partial
76
which seizure has hallucinations and automatisms
complex partial
77
EEG shows 3 cycle spike and wave pattern
absence seizure
78
what drug is given to stop status epilepticus
benzo
79
signs of PArkinson
```
shuffling gait
masked facies
akinesia
rigidity cogwheel
tremor resting
```
80
pill rolling resting tremor
parkinsons
81
how to Dx ALS
Dx of exclusion
| LMN signs at least 2 extremities and UMN in one region
82
Tx ALS
riluzole
83
what is main cause death in ALS patients
respiratory failure
84
Inheritance Huntington and mutation
auto dominant. CAG repeats on chromosome 4. more repeats = earlier disease
85
signs huntingtons
progressive rapid irregular involuntary movements (chorea) dementia, possible seizures
86
adverse effects levodopa
nausea vomiting, anorexia, tachycardia, hallucination, modd changes, dyskinesia!!!
87
how does amantadine work
increase synthesis and release or reuptake dopamine
88
what helps with rigidity and bradykinesia in parkinsons
amantadine
89
Radiology of huntingtons
CT or MRI show cuadate nucleus atrophy
90
Tx for huntingtons
dopamine antagonists may improve chorea
91
initial complains MS
vertigo, visual abnormalities, paresthesias, weakness, urinary retention
92
late Sx of MS
poor movement control, difficulty speaking, sensory abnormalities, postural and positional instabilities, spasticity, increased DTRs and + babinski
93
LP of MS
increased protein, mildly increased WBCs, oligoclonal bands and increased IgG
94
what to order is suspect MS
MRI looking for white matter lsions
| LP looking for oligoclonal bands
95
Tx syringomyelia
surgical decompression, shunting and supportive care
96
what causes labert eaton
Ab to presynaptic Ca channels
97
tensilon test
when edrophonium is given, Myasthenia Sx improve
98
What are the anticholinesterase drugs
neostigmine and pyridostigmine
99
what must you do if you Dx someone with myasthenia gravis
do a chest CT looking for thymoma
100
athetosis
writhing snakelike, cerebral palsy, huntington, wilson
101
what causes hemiballismus
stroke in subthalamic nucleus. give haloperidol
102
Most common brain tumor in adults
glioblastoma
103
most common primary brain tumor in children
astrocytoma
104
what is the most common Malignant brain tumor in children
medulloblastoma
105
metastasis to brain go where
supratentorial
106
if find intracranial tumor
search rest of body for primary
107
NF1, con recklinghausen
Auto dominatnt on chrom 17
108
NF2
auto dominant on chrom 22
109
which NF causes bilateral acoustic neuromas
NF2
110
signs NF 1
```
cafe au lait spots
neurofibromas
axillary or inguinal freckles
optic glioma
iris hamartoma
bone lesions
relative with NF1
```
111
half of sleep is in what stage
intermediate with sleep spindles and K complexes on EEG
112
hwo do benzos work on sleep schedule
increase N2 decrease N3(deep sleep)
113
Tx narcolepsy
modafinil, methylphenidate, pemoline
114
patient in coma with pinpoint pupils
opioid overdose
115
patient in coma with large nonreactive pupils
damage below midbrain, possible unclahernation
116
if patient in coma, put ice water in ear and they have conjugate deviation toward water
intact midbrain
117
decorticate
elbow flexed, legs extended
| cortical or thalamic compression
118
decrebrate
elbows extended and legs extended
| midbrain involvement
119
no response to pain in coma
pontine and medullary involvement
120
most common seizure in children
febrile
121
hydrocephalus in children with anatomic defects
arnold chiari type II and dandy-walker
122
tay sachs
auto recessive
| absence hexosaminidase A needed for lipid ganglioside metabolism
123
risk factors tay sachs
ashkenazi jew, french canadian
124
cherry red spot on retina
tay sachs
125
prognosis tay sachs
death first few years
126
risk factors for Neural tube defects
anticonvulsant use or poor folate intake, maternal DM
127
how does quad screen detect NT defects
increased AFP and ACE
128
risk factors Cerebral palsy
prematurity, IUGR, birth trauma, neonatal seizures or hemorrhage, perinatal asphyxia, multiple births, intrauterine infection
129
types of CP
spastic-- pyramidal tracts: increased tone, increased DTRs, weakness, gait abnormalities, mental retardation
dyskinetic-- extra pyramidal: choreoathetoid, dystonic, ataxic that worsen with stress
130
what maintains conjugate gaze when one eye abducts
Medial longitudinal fasciculus
131
accomodation to near objects and nonreactive to light
argyll robertson pupil: syphilis, SLE or DM
132
minimally reactive dilated pupil
adie pupil from abnormal innervation iris
133
what can cause an absent ipsilateral eye adduction with lateral gaze
MLF lesion or MS
134
myopia vs hyperopia
myopia focal point is anterior to retina
| hyperopia focal point is posterior to retina
135
amblyopia
developmental defect causing poor visual acuity and spatial differentiaion
136
Tx amyblyopia
correct visual acuity in affected eye and patch unaffected eye to promote use of affected
137
Anterior uveitis
pain and photophobia, slit lamp show inflammation of eye and keratin deposits on cornea
138
posterior uveitis
mild vision abnormalities, eye inflammation and retinal lesions
139
most common cause conjunctivitis
adenovirus
140
risk factors open angle glaucoma
age, increased IOP, DM, black, myopia, family Hx
141
vision loss in open angle
chronic from peripheral to central. see halo around light. cupping of optic disc
142
Dx open agnle glaucoma
tonometry every 2-4 weeks
143
Tx open angle glaucoma
topical beta blocker, alpha agonist(decrease production), PG analogues, cholinergic agonists(remove aqueous humor)
144
risk factors closed angle glaucoma
increased age, asian, hyperopia, dilated pupils
145
eye is inflamed and hard with dilated nonreactive pupil
closed angle glaucoma
146
patient needing frequent changes of lens prescriptions
suspect open angle glaucoma
147
Tx closed angle glaucoma
timolol, apraclonidine, pilocarpine eyedrops oral IV acetazolamide or IV mannitol
148
most common cause bilateral vision loss in elderly
macular degeneration
149
risk factors macular degeneration
white tobaco, FMH, inc age, prolonged sunlight, HTN female>male
150
vision loss in macular degeneration
central to peripheral
| possible retinal detachment
151
Tx macular degeneration
Vit C E and beta carotene, copper and zine
| intravitreal ranibizumab
152
Tx retinal detachment
laster photocoagulation or crytotherapy
153
what causes retinal vessel occlusion
atherosclerosis
| DM HTN, thromboembolic disease
154
sudden painless loss vision
retinary artery occlusion
155
what you see on retinal a occlusion on fundoscopi
cherry red spot in fovea
156
descriptions presentation retinal vein occlusion
more gradual painless loss vision
| fundoscope shows cotton wool spots, edema, retinal hemorrhages and dilated veins
157
what is used for otitis externa
polymyxin, neomycin, hydrocortisone, oral cephalosporins, cipro
158
meniere disease
vertigo from distension of endolymphatic compartment of inner ear
acute vertigo for hours, nausea, vomiting, decreased hearing, tinnitus
will lose low frequency!
159
conductive hearing loss
preserved bone conduction, air conduction shows low hearing threshold
abnormal rhinne
160
sensorinueral hearing loss
impaired bone and air conduction. asymmetric weber, normal rhinne
from neural pathway deficit
161
what type of hearing loss with acoustic neuroma
sensorineural
162
risk factor alzheimer
increased age, FMH, trisomy 21, F>M
163
cortical atrophy dementia
alzheimers
164
what type med for alzheimer
cholinesterase inhibitors like donepezil and rivastigmine
165
pick disease, frontotemporal
intracellular inclusions tau protein
has behavioral variant and aphasia variant
bilateral frontal atrophy
166
Tx picks disease
SSRI trazadone, atypical antipsychotics
167
lewy body dementia
intracell cortical inclusions lewy bodies (alpha synuclein)
fluctuating congnition, impaired attention, visual hallucinations, syncope, frequent falls, limb rigidity, bradykinesa or akinesia, gait distubrance
168
which dementia has parkinsonian Sx
lewy body
169
NPH
wet weird wobbly
| LP show normal P but improves symptoms
170
Tx NPH
VP shunt
171
what not to use in delierium
benzos or anticholinergics
