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primera etapa > neurologia > Flashcards

neurologia Flashcards

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1
Q

stroke:
brocas afasia que es y que arteria afecta?

A

brocas afasia: habla con palabras cortas, entiende bien, no puede repetir

Middle cerebral artery (motor+senstivo contralateral, ojos ven hacia el lado de la lesion)

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2
Q

tx para cataplexia presente en narcolepsia que se toma en la noche?

A

Sodium oxybate and/or pitolisant

cataplexia: symptom of narcolepsy characterized by sudden muscle weakness in a fully conscious patient that is triggered by strong emotions (e.g., patients may experience buckling of the knees upon laughing). Self-resolves in < 2 minutes.

patient presents with cataplexy, hypnagogic hallucinations, sleep paralysis, and excessive daytime sleepiness despite good sleep hygiene. These symptoms are characteristic of narcolepsy.

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3
Q

parkinson, patologia?

A

destruccion dopamina en sustancia nigra (basal ganglia)

sino hay dopamina no se controlan los movimientos de la corteza motora, lo q causa los sintomas motores como tremor, rigidez etc

el tremor mejora al hacer movimientos voluntarios

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4
Q

pronator drift, donde esta la lesion?

A

upper motor neuron lesion,
middle cerebral artery

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5
Q

local anesthetic, amide group, long acting?

A

bupivacaine

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6
Q

what is acute cerebellar ataxia?

A

cerebellar disfunction usually en menores de 6 años que sucede después de enfermedad febril

clinical manifestations depend on the structure affected within the cerebellum.

a) Vermis of the cerebellum:
- broad-based gait and gait instability
-truncal ataxia
-dysmetria (which can also result from damage to the cerebellar hemispheres)
-saccadic intrusions
-vertigo

b)cerebellar hemispheres:
-scanning speech
-dysdiadochokinesis
-intention tremor
-limb ataxia
-nystagmus

Acute cerebellar ataxia commonly affects both midline cerebellar structures and cerebellar hemispheres.

Although now uncommon in the US because of widespread vaccination, VZV infection was once the most common cause of acute cerebellar ataxia.

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7
Q

crisis de ausencia tx? en menor de 8 años

A

Ethosuximide

Reproduction of these findings via hyperventilation and EEG findings of a 3-Hz spike and wave pattern further support the diagnosis

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8
Q

crisis de ausencia tx en mayor de 9 años

A

valpron

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9
Q

Von Hippel Sindau disease caracteristicas y patron genetics?

A

mnemonic “HARP”:

  1. Hemangioblastoma (retina, brainsteam, cerebello, medula espinal)
  2. Angiomas (piel, mucosa, organos)
  3. Renal carcinoma bilateral
  4. Pheocromositoma

Autosomal dominante

Any patient presenting with CNS or retinal hemangioblastoma before the age of 50 years should undergo testing for VHL disease.

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10
Q

Parkinson monotherapy in patients < 65 years of age with tremor as the main symptom?

A

Benztropine
Trihexyphenidyl
Biperiden

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11
Q

parkinson tx that can cuase livedo reticularis + peripheral edema + ataxia as side effect?

A

amantadine

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12
Q

miestenia gravis: patologia, que pasa con el ejercicio y tx?

a que se asocia?

A

anticuerpos contra acetilcolina
sx: diplopia, ptosis, proximal weakness

ptosis mejora al ponerle hielo

EMPEORA sx a traves del dia/ejercicio

tx: pyridostigmine

asocia a timoma (hacer tac de tórax) y tiroditis Hashimoto

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13
Q

CSF en guillan barre muestra? y q patogeno lo causa?

A

albuminocytologic dissociation (CSF with a high protein level but normal WBCs)

ascending flaccid paralysis after bloody diarrhea caused by campylobacter causa demilinizacion autoinmune segmentada (molecular mimicry)

The bugs that are associated with Guillain-Barré syndrome are ICE MyCZ: Influenza virus, Cytomegalovirus, EBV, Mycoplasma pneumoniae, Campylobacter, Zika virus

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14
Q

Migraine prophylaxis indications?

A

frequent attacks (≥ 3 attacks/month),
long-lasting attacks (e.g., > 12–24 hours),
migraine that is preceded by an aura.

First line
Propanolol
anticonvulsivantes: topiramate/valpron

Second line
antidepresiv triciclicos: amitriptilina

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15
Q

lateral and inferior eye deviation at rest +dilated pupil that does not react to light
Que CN esta afectado?

A

oculomotor nerve (CN III) palsy. Somatic and parasympathetic involvement.

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16
Q

afectacion somatica y parasimatica del CN III (oculomotor) donde esta la lesion?

A

posterior communicating artery

CN III, leading to an ipsilateral dilated pupil with a “down and out” gaze

Compressive lesions are characterized by pupillary involvement due to injury to the outer parasympathetic layer of CN III (which controls pupil dilation, light reactivity, and accommodation). Additional injury to the deeper somatic fibers of the nerve (which control extraocular muscles) is responsible for this patient’s ptosis and “down and out” gaze. Acute CN III palsy due to a cerebral aneurysm is very concerning for imminent rupture. A patient presenting with dilated pupils and a history of recent headaches should undergo an urgent MRI with MR angiography.

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17
Q

tx malignant otitis externa?

A

IV ciprofloxacina =+ otro antiseudomonas (cefepime, ceftazidime o pip/tazo)

malignant otitis externa most commonly cause by pseudomonas aeruginosa

Malignant otitis externa is an emergency that can progress to osteomyelitis of the skull base

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18
Q

inherited retinoblastoma gene mutations have a significantly increased risk of ____?

A

osteosarcomas and pinealomas.

inherited retinoblastoma gene mutations (Rb gene mutations) have a significantly increased risk of developing osteosarcomas and pinealomas.

The characteristic clinical features of retinoblastomas are leukocoria (white fundal reflex instead of the usual red) and strabismus.

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19
Q

Cerebral venous thrombosis aguda y aseptica (causa no infecciosa). First line tx?

A

Low weight heparin ejemplo deltaparin

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20
Q

edema subcortical en sustencia blanca del cerebro

IMPORTANTE

A

encefalopatía posterior reversible

CSF: midly elevated proteins, everything else normal

asociado a:
tx imunosupresor y antineoplasico
hipertension severa

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21
Q

encefalopatía posterior reversible. Sx, MRI and lumbar puncture findings? associated to?

A

Sx:

convulsiones,
visual disturbances
altered mental status
headache constant that doesnt improve with analgesics
se diferencia de CVT porq no hay aumento en ICP Y EN CVT si, EPR esta mas asociado a imunosupresores y CVT a anticonceptivos

associated to? inmunosupresores, antineoplasicos, hipertension severa

MRI: edema subcortical en sustancia blanca

LP: proteins midly increased, everything else normal

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22
Q

Acute disseminated encephalomyelitis findings on CSF?

A

WBC ^
Proteins ^

headache, altered mental status, impaired vision, and multiple bilateral lesions in the white matter on MRI imaging.

mostly affects children and young adults and is typically preceded by vaccination or viral infection.

immune-mediated, demyelinating CNS disease caused by cross-reaction hypersensitivity between viral antigens and myelin. It usually develops after viral infections or, rarely, after vaccination.

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23
Q

que hace la cocaina en los vasos y cuales son las consecuencias?

A

cocaina causa vasoespasmo, consecuencias:

stroke isquémico o hemorragico
cardiac ischemia, prinzmetal angina
hipertension (porq inhibe la recaptura de serotonina, noepinefrina, dopamina)

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24
Q

Charcot triat de esclerósis multiple decir los sx?

A

scanning speech, nystagmus, and intention tremors.

Often used to describe cerebellar involvement in multiple sclerosis but can occur with any cerebellar lesion.

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25
diabetic neuropathy sx
parestesias debilidad simetrica distal perdida propiocepcion perdida temperatura Diabetic neuropathy may cause cranial nerve palsies, especially affecting extraocular muscles [CN III, IV, and VI]
26
Wilsons disease. Tx?
Penicillamine
27
normal pressure hydrocephalus (NPH) sx? dx y findings? tx?
3W: Wacky (demencia) Wet (urinary incontinence) Wobbly: (inestabilidad al caminar +magnetic gait que es shuffling as if the feet are glued to the ground DX MRI: ventriculos grandes, sulci disminuido CSF ^ en openinf pressure Tx: ventriculoperitoneal shunt
28
head trauma > initial loss of consciousness > LUCID INTERVAL Dx? que se ve en imagen? arteria afectada?
EPIDURAL hemorrhage tac sin contraste: CONVEXO A. meningea media
29
hemorragia subaracnoidea complicación y como evitarla?
vasoespasmo (4-10 d después) dar nimodipina oral
30
subdural hematoma? epidemiología y com ose ve en ct
truma, viejos, alcoholicos, shaken baby sd ct: hemiluna
31
worst headache of my life precedido por ___?
hemorragia subaracnoidea precedido por sentinel bleed "warning leak"
32
Which type of cranial hematoma involves a fixed dilated pupil and contralateral hemiparesis?
Acute epidural hematoma
33
essential tremor tx?
propanolol (preferido) primidone ( could trigger acute intermittent porphyria) worsens with action/voluntary movement
34
convulsion de ausencia que se ve en EEG y tx?
EEG: 3 Hz spike-and-slow-wave complexes on EEG tx: ethosuximide no presenta posictal, dura 5-10 segs. can be triggered by hypoventilation
35
Parkinson ≤ 65 y.o if the main symptom is resting tremor. Tx?
Trihexifenidilo, Benztropina
36
severe unilateral headache + ipsilateral cranial autonomic symptoms (conjunctival injection, lacrimation) dx, tx?
dx: cefalea en racimos last from 15 minutes to 3 hours tx: oxygen therapy
37
multiple ring enhancing lesions in ct scan + hiv <100 cd4 DX? tx?
Toxoplasmosis cerebral tx? sulfadiazine + pirimetamina
38
aura+staring+posinctal. dx?
Focal seizure with impaired awareness eeg: temporal
39
neuropathy in DM causes:
1)incomplete bladder emptying > ^ UTI and overflow incontinence 2) gastroparesis: sensation of fullness pospandrial, nausea, vomit, bloating 3) constipation 4) erectile dysfunction 5) postural hypotension due to damage to small-fiber autonomic nerves. In diabetes, peripheral neuropathy and autonomic neuropathy occur as a result of osmotic damage to Schwann cells
40
stabbing, unilateral facial pain lasting several seconds. dx?
neuralgia del trigemino (episodios duran< 1 minuto) tx: 1* carbamazepina // ozcarbazepina 2* descompresión microvascular
41
esclerósis leteral amiotrofica. tx?
riluzol (mechanism: decreases glutamate excitotoxicity)
42
Cortical laminar necrosis is a hallmark of prolonged seizures and can lead to persistent neurologic deficits and recurrent seizures. Verdadero o falso??
verdadero associated with repeated seizures, hypoxia, and hypoglycemia. The clinical features depend on the affected cortical area and may include motor dysfunction, vision impairment, and aphasia. CLN can also result in additional seizures, increasing the risk for further cortical damage.
43
ring enhancing lesion+EBV association+ HIV dx?
CNS lymphoma
44
CNS lymphoma tx?
metrotexate high dose + leucovin quimioterapia
45
que screening se le hace a todos los Amilotrophic lateral sclerosis?
bedside swallowing test aka detección a pie de cama del riesgo de aspiración asociado con la disfagia
46
most common cause of watershed infarct?
systemic hypotension
47
Increased methylmalonic acid. dx?
vitamin b12 deficiency
48
cual es la diferencia entre Dtap y Tdap?
DTaP: ninos 6 weeks-7 years. tanto para inmunidad como para postexposure profilaxis Tdap: individuals ≥ 7 years of age for routine Tdap boosters, postexposure tetanus prophylaxis, and catch-up immunization for those with incomplete DTaP vaccination.
49
localize the lesion. stroke: sx motores contralateral UNICAMENTE + + weakness in the lower half of the face arteria afectada?
Contralateral lenticulostriate artery located in posterior limb of the internal capsule,
50
localize the lesion. stroke: sx motores contralateral + sensory changes, gaze deviation, and aphasia (dominant hemisphere) or hemineglect (non-dominant hemisphere). arteria afectada?
A. cerebral media contralateral afecta mas upper limb
51
localize the lesion. stroke: sx motor + impaired pain / proprioception + hypoglossal nerve palsy (e.g., inability to protrude the tongue, tongue deviation). arteria afectada?
A. espinal anterior
52
stroke localizar lesion" contralat motor/sensitivo miembro INFERIOR solamente + se orina + abulia arteria lesionada?
A. cerebral anterior contralateral afecta mas lower limb
53
localiza stroke Contralateral sensory loss + Contralateral homonymous hemianopsia with macular sparing
A. posterior cerebral contralat
54
stroke ubicar lesion: horner ipsi (miosis + ptosis) + pain and temperature loss ipsi face body contra se cae ipsi decreased gag reflex
A. cerebelar posterior inferior (wallenberg sd)
55
que atb pueden causar polineuropatia distal simetrica?
fluoroquinolonas. isoniazida metronidazol
56
atb que causa boca con sabor a monedas + dolor de cabeza +dolor de barriga ?
metronidazole
57
natalizumab aumenta riesgo de :
Progressive multifocal leukoencephalopathy
58
What is the likely cause of anion gap metabolic acidosis in a patient with a recent generalized tonic-clonic seizure?
Post-ictal lactic acidosis bicarbonato serico elevado, se quita en dos horas no requiere manejo
59
multiple sclerosis CSF findings?
Oligoclonal bands Lymphocytic pleocytosis Increased myelin basic protein levels.
60
stroke: donde esta la lesion? Miotic and nonreactive pupils + gaze deviation downward and TOWARDS the AFFECTED side of the body
lesion is: thalamic hemorrhage. lesion is called “wrong way eyes” (porq los ojos estan viendo HACIA el lado de la lesion, es decir, la hemiparesia y los ojos estan en el mismo lado), la lesion es contralateral
61
What is the recommended empiric treatment for suspected bacterial meningitis in neonates (<1 month old)?
Ampicillin + gentamicin AND/OR cefotaxime
62
empiric therapy of choice for immunocompromised patients with suspected bacterial meningitis?
Ampi + vanco + cefepime OR meropenem Additionally administering dexamethasone to reduce the risk of hearing loss may be considered for children with bacterial meningitis, especially if infection with Haemophilus influenzae type b is suspected
63
Bilateral temporal lobe involvement on an MRI of the brain is pathognomonic of ?
HSV encephalitis
64
alzheimer neurotrasmisor afectado?
acetilcolina extra: Alzheimer is caused by the degeneration of cholinergic neurons leading to decreased acetylcholine synthesis and impaired cholinergic transmission to the cortex. First-line pharmacotherapy for mild to moderate AD is acetylcholinesterase inhibitors (e.g., donepezil).
65
parkinson neurotransmisor afectado?
dopamina
66
India ink stain dx y tx?
dx: Cryptococcus neoformans tx: Amphotericin B and flucytosine
67
alzheimer patofisiologia?
extracellular amyloid plaques and intracellular neurofibrillary tangles Acetylcholine deficiency presentacion temprana en pt con down sd.
68
lewys bodies patofisiologia
alfa-sinucleína agregacion intracelular
69
Creutzfeldt-Jakob diseas patofisiologia
prion protein pre synaptic build up
70
frontotemporal dementia fisiopatologia?
Cytoplasmic inclusions of ubiquitinated TDP-43
71
profilaxis de migraña, tension headache, cluster headache?
migraña: propanolol tension headache: amitriptilina cluster headache: verapamil
72
tumor cerebral en niños que obstruye/deforma/invade el 4to ventriculo y causa hidrocefalia?
ependimoma MALIGNO obstructive hydrocephalus and will appear as a mass with scattered calcifications most commonly within the 4th ventricle
73
restless leg syndrome tx?
intermitente (ess than twice per week): Carbidopa-levodopa cronico: gabapentin / pregabalin restless leg syndrome associated with iron deficiency and chronic kidney disease?
74
stroke: where is the lesion? pure motor stroke
internal capsule posterior limb contralateral The most common subtype of a(n) lacunar stroke is a pure motor stroke, resulting in contralateral hemiparesis of the face, arm, and leg Lipohyalinosis of the lenticulostriate arteries is the most common cause of pure motor strokes and typically affects the posterior limb of the internal capsule, i
75
stroke: where is the lesion pure sensory stroke
talamo contralateral contralateral numbness and paresthesia of the face, arm, and leg
76
alzheimer tx?
mild-moderate "DON RIVA forgot GALA": inhibitors de acetilcolesterasa Donepezil Rivastigmine Galantamine Moderate-severe: (≤ 18/30 MMSE) NMDA receptor antagonist: Memantine (se combina con donepezil)
77
Esclerosis lateral amiotrófica. como se confirma el dx?
electromiografia
78
tremor that worsens with purposeful voluntary movement (e.g., finger-to-nose test) and Improves with alcohol dx and tx?
tremor essential tx Primidona o Propanolol (no usar si hay asma) diferencia con Parkinson: the tremor in parkinson is typically asymmetrical and improves rather than worsens with purposeful voluntary movement. Parkinson tremor = worse during rest Essential tremor = worse during movement
79
Transient ischemic attack (TIA), dx?
MRI
80
caso de N. meningitidis, tx del paciente y tx de los contactos?
pt: Vanco+ceftriaxona o cefotaxime (3 gen cefalosporina) contactos: TODOS rifampicina, ciprofloxacin, or ceftriaxone Rifampin is indicated for PEP in all close contacts (i.e., the patient's brother and parents). PEP is important to prevent infection, and to eliminate nasopharyngeal carriage of N. meningitidis, thus limiting disease transmission.
81
What is the empiric treatment for suspected bacterial meningitis in adults and children >1 month?
Vancomycin + ceftriaxone If >50 years old, add ampicillin
82
ataxia de Friedrich etiologia, sx? causa #1 de muerte?
FRiedreich ATAXia have ATAXic GAAit due to the expansion of the triplet GAA in the FRATAXin gene. auto rest, cromosoma 9, pies cavus (arco alto) dedos en martillo ataxia cause #1 de muerte: heart failure due to cardiomiopatia HIPERtrofica
83
hallazgo en liquido cefalórraquideo en guillan barre y que significa? tx?
disociación albuminocitológica significa: aumento de proteínas sin un aumento similar en el recuento de glóbulos blancos (< 10) recuerda: proteina normal en LCR 20-40 y leucos <5 immunoglobulina iv+ plasmaferesi
84
Progressive memory impairment in an individual with cardiovascular disease+focal neurologic deficits diagnostico? q sale en el tac?
vascular dementia CT scan: hypodense periventricular lesions importante: puede haber deficits neurologicos focales
85
Hunginton disease: neuroimaging findings? genetica?
Neuroimagen: 1. atrofia de caudado y putamen 2. ventriculomegalia Genetica: -Aut Dominant. CAG repet in Cromosoma 4: -"CAG": Caudate loss, Ach loss, Gaba loss. -Perdida de GABA y Ach
86
tx Amyotrophic lateral sclerosis?
riLOUzole (disminuye glutamato) esclerosis lateral amiotrófica tambn le dicen enfermedad de LOU Gehrig <<
87
hand pain paresthesia that worsens at night and by hand elevation over head? dx? etiologia?
carpal tunnel sd, MEDIAN nerve compression etiologia: Pressing Down HARD P: pregnancy D: dialisis related amyloidosis H: hipotiroidismo A: acromegalia R: rheumatoid arthriti / Repetitive movement D: diabetes
88
miestenia gravis tx?
piridostigmina MG: acetilcolina antibodies apenas se dx hacer tac de pecho para rule out timoma
89
Management of facial nerve paralysis after TRAUMATIC facial injury depends on symptom onset cuales son los tx?
Acute: surgical repair Delayed (1-2 days after trauma): steroid therapy, if doesnt work do surgical decompression of facial nerve Peripheral facial nerve palsy following facial trauma is caused by temporal bone fracture or trauma.
90
MRI of the brain often reveals hyperintensity of the cerebral cortex (ie, cortical ribboning) and the putamen and caudate head (ie, hockey stick sign) this is charactristic for what disease?
Creutzfeldt-Jakob disease
91
preservacion macular SI. Arteria afectada? preservacion macular NO
preservada: Posterior Cerebral Artery no preservada: Middle cerebral artery

primera etapa (29 decks)

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