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Flashcards in Neuro and optho from Step Up Deck (171):
1

ALS affects what tracts

corticospinal tract and ventral horn

2

poliomyeltisis affects what tracts

ventral horn causing flaccid paralysis

3

tertiary syphilis or tabes dorsalis affects what tracts

dorsal columns impairing proprioception and pain

4

what is spinal artery syndrome

bilateral loss of pain and temp below lesion and bilateral spastic paresis below with flaccid paralysis at the level

5

whats affected in spinal artery syndrome

corticospinal track, spinothalamic tract, ventral horn, lateral gray matter

6

What tracts does Vit B12 deficieny affect

dorsal columns and corticospinal tract leading to bilateral loss of vibration and discrimination with bilateral spastic paresis affecting legs before arms

7

what tracts are affected in syringomyelia

ventral horn and ventral white commissure

8

Signs of syringomyelia

bilateral loss of pain and temp below and flaccid at the level

9

what is brown sequard syndrome

ispi loss vibration and discrimination blow. ipsi spastic paresis below
ipsi flaccid paralysis at level
contra loss pain and temp below

10

what tracts are affected in brown sequard syndrome

all tracts on one side of the cord

11

Brudzinski

neck flexion in supine causes hip flexion

12

What rash is seen in N meningitis

petechiae

13

Tx meningtitis bacterial

cephalosporins usually 3rd gen
close contacts given rifampin or cipro for porphylaxis

14

what are signs of incrreased intracranial P

papilledema, focal neurologic deficits, pupil asymmetry

15

why no do LP if signs of intracranial P

increased risk of uncal herniation

16

Tx fungal meningitis

amphotericin B

17

Tx TB meningitis

RIPE

18

most common cause meningitis in newborn

Group B strep

19

common meningitis in 1 mo-2 year

strep pneumo and N meningitis

20

common cause meningitis 2-18 year

N meningitis

21

cause meningitis in 18-60+ y.o

S pneumo

22

CSF bacterial meningitis

increased PMNs
increased pressure
decrease glucose
increase protein

23

CSF in viral meningitis

increased lymphocytes
increased pressure
normal glucose
normal protein

24

Malaise, HA, comiting, neck pain, dec consciousness and change in mental status with focal neurologic deficitis

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