Neurology Flashcards
1
Q
When a patient arrives to the ER who has signs of a stroke, what is the first initial step?
A
get a CT scan without contrast
*need to know if it is hemorrhagic or ischemic stroke
2
Q
What are two main differences between a TIA and a stroke?
A
- a stroke will last longer than 24 hours
- a stroke does NOT involve the upper third of the face (from the eyes up- patient will be able to move forehead)
- A TIA lasts LESS than 24 hours
- A TIA INVOLVES the upper third of the face
3
Q
A TIA is always caused by?
A
emboli or thrombosis
4
Q
Patient experiences a transient loss of vision in one eye. What is this called? And what artery must the emboli or thrombus be located in?
A
- amaurosis fugax
2. ophthalmic artery (first branch of the internal carotid artery)
5
Q
Define cryptogenic stroke
A
A stroke with an unknown etiology
- can only be diagnosed after 1-3 months of EKG monitoring
6
Q
Based on the following symptoms, which artery in the brain has a lesion?
- PROFOUND LOWER extremity weakness
- mild upper extremity weakness
- personality changes or psychiatric disturbance
- urinary incontinence
A
Anterior cerebral artery
7
Q
Based on the following symptoms, which artery in the brain has a lesion?
- PROFOUND UPPER extremity weakness
- aphasia
- apraxia
- eyes deviate towards side of lesion
- CONTRALATERAL homonymous hemianopsia with macular sparing
A
Middle cerebral artery
8
Q
Based on the following symptoms, which artery in the brain has a lesion?
- inability to recognize the face (prosopagnosia)
A
Posterior cerebral artery
9
Q
Based on the following symptoms, which artery in the brain has a lesion?
- vertigo
- nausea and vomiting
- loss of consciousness
- dysarthria and dystonia
- sensory changes in the face and scalp
- ataxia
- bilateral findings
A
Vertebrobasilar artery
10
Q
Based on the following symptoms, which artery in the brain has a lesion?
- ipsilateral face involvement
- contralateral body
- vertigo
- horner syndrome
A
Posterior Inferior Cerebral Artery
11
Q
Based on the following symptoms, which artery in the brain has a lesion?
- absence of cortical deficits
- ataxia
- Parkinsonian signs
- sensory deficits
- hemiparesis (most notable in the face)
- possible bulbar signs
A
Lacunar infarct
12
Q
What is the most accurate test in diagnosing a stroke?
A
MRA
13
Q
What is the time window to give tPA?
A
3-4.5 hours of onset of stroke
14
Q
All patients with nonhemorrhagic strokes should have which medication added to their regimen if not already on it?
A
statin
15
Q
What are the ABSOLUTE contraindications to giving tPA?
A
- history of hemorrhagic stroke
- presence of intracranial neoplasm/mass
- has bleeding disorder
- active bleeding
- surgery within the last 6 months
- CPR with chest compressions within the last 3 weeks
- suspicion of aortic dissection
16
Q
If the patient is in the appropriate time window to give tPA, what 4 conditions must be met before it is given?
A
- patient should be <80
- patient is not a diabetic with a previous stroke
- does not use anticoagulation
- NIH stroke scale is less than 25
17
Q
If the patient has had the stroke over 4.5 hours, what is the best initial step?
A
- Give the patient aspirin
18
Q
What is the best way to remove a clot that caused a stroke?
A
- removal of clot via catheter
19
Q
If patient was already on aspirin and develops a stroke, which medication should you switch to?
A
- clopidogrel
20
Q
What is the time frame window to remove a clot that caused a stroke via catheter?
A
- up to 24 hours of the initial onset of the stroke
21
Q
Cerebral vein thrombosis can mimic?
A
subarachnoid hemorrhage
22
Q
How does cerebral vein thrombosis present?
A
Patient will have headache developing over several days with weakness and difficulty with speech, as seen in a stroke victim.
23
Q
What is the most accurate test to diagnose cerebral vein thrombosis?
A
MRV (magnetic resonance venography)
24
Q
What is the treatment for cerebral vein thrombosis?
A
- LMW heparin followed by warfarin for a few months after
25
Treatment for TIA?
- aspirin and clopidogrel for the first several weeks after TIA
* tPA is NOT indicated
26
What tests should be ordered after CT scan without contrast for patients suspected of stroke or TIA?
- carotid doppler
- echocardiogram
- EKG and holter monitor
27
A young patient <50 y/o with no past medical history, in addition to the normal tests run after a stroke or TIA, what additional tests should be ordered?
- ESR
- VDRL or RPR
- ANA
- dsDNA
- protein C
- protein S
- factor V leiden mutation
28
A patient on a statin due to hyperlipidemia, what is the goal of the LDL with the statin?
<70 mg/dL
29
When is an endarterectomy indicated?
- Patient must be symptomatic AND must be >70 but <100 % stenosis of the artery
30
When is closure of a patent foramen ovale the next step in management?
- patient has an embolic appearing cryptogenic ischemic stroke
- right to left shunt detected by a bubble study
31
What is the initial medication used for a seizure?
- benzodiazepines (BZD)
32
After giving lorazepam to a patient with status epilepticus, what is the next medication to add if the seizure continues after 20 minutes?
- Fosphenytoin
33
Patient has been seizing for the last 40 minutes. Lorazepam and fosphenytoin have not stopped the seizure. What is the next line of therapy?
- phenobarbital
34
If a patient is still seizing after 60 minutes, and lorazepam, fosphenytoin, and phenobarbital have not ceased the seizure, what is the next class of medication to use?
- general anesthesia (propofol, pentobarbital, thiopental, midazolam)
35
Patient comes in with a seizure. After the seizure has ceased, what tests should be ordered?
- CBC
- CMP
- glucose
- Creatinine
- Head CT
- urine tox
* EEG only if the other tests do not reveal anything
36
On the CCS exam, any time a patient has a seizure, who should be consulted?
- Neurology
37
What are some first line medications for chronic seizures?
- levetiracetam
- valproic acid
- carbamazepine
- phenytoin
38
If a patient should need to be on lamotrigine, what test can be done to predict Stevens-Johnson syndrome?
HLA-B*1502
39
What are the safest seizure meds in pregnancy?
- levetiracetam
| - lamotrigine
40
What is the worst seizure med in pregnancy?
- valproic acid
41
If a patient is on OCP, which seizure med will be affected and therefore will need a higher dose to maintain efficacy?
- lamotrigine
42
What are some second line medications for seizures?
- gabapentin
- phenobarbital
- lacosamide
- zonisamide
43
Best treatment for absence or petit mal seizures?
ethosuximide
44
which seizure drug has the highest risk of hyponatremia?
carbamazepine
45
What are some drugs that can cause parkinsonian symptoms?
- antispychotics >1st gen than 2nd gen
- antiemetics that inhibit dopamine
- prochlorperazine
- metoclopramide
46
What are some physical findings in parkinson disease?
- cogwheel rigidity
- resting tremor
- hypomimia ( a masklike, underreactive face)
- micrographia (small writing)
- orthostasis
- intact cognition and memory
47
First line tx for patient >60 y/o with mild parkinson disease
amantadine
48
first line tx for patient <60 y/o with mild parkinson disease
benztropine or trihexyphenidyl
49
first line for patient with severe parkinson disease (cannot perform activities of daily living)
- levodopa/carbidopa combo
50
Second line tx for severe parkinson disease
dopamine agonists, like pramipexole, ropinirole, cabergoline, rotigotine, apomorphine
51
What are some adjuncts to control parkinson disease if the primary treatment is not working alone?
- COMT inhibitors, like tolcapone and entacapone
| - MAO inhibitors, like selegiline, rasagiline, safinamide
52
Define shy-drager syndrome
- parkinson disease with orthostatic hypotension
53
Tx for shy-drager syndrome
- fludrocortisone or midodrine
54
MOA of midodrine
- alpha 1 agonist (raises blood pressure)
55
What is the main difference between progressive supranuclear palsy and parkinson disease?
- A patient with progressive supranuclear palsy cannot look up or down- vertical gaze paralysis
56
A patient with parkinson disease is on levodopa/carbidopa combo and develops psychosis. What can be added to the regimen to control the psychosis?
- quetiapine or pimavanserin
57
A patient with Parkinson disease is admitted to the hospital. The medical staff is unaware that he is treated for parkinson disease. What can happen while he is in the hospital without parkinson treatment?
- fever/rhabdomyolysis
58
define essential tremor
- a tremor that occurs at rest and with intentions bilaterally
- not associated with an illness
59
first line tx for essential tremor
beta-blockers, specifically propanolol
60
If patient still has an essential tremor after being on propanolol, what is the next adjunct medication?
primidone (antiepileptic medication)
61
Resting tremor in parkinson disease is treated with?
amantadine
62
What are some abnormalities associated with multiple sclerosis?
- optic neuritis
- motor and sensory issues
- atonic bladder
- fatigue
- depression
- hyperreflexia
- spasticity
63
What is the best initial and accurate test for MS?
MRI
64
Patients with MS will show what on their lumbar puncture?
- oligoclonal bands
65
LP is only performed when _____ with an MS patient.
the MRI is undiagnostic
66
Which drug class decreases the progression of MS?
anti-CD20 drugs
67
Baclofen or tizanidine treat ___ for MS patients.
spasticity
68
dalfampridine helps ____ with patients with MS.
increases walking speed
69
Amantadine is used to treat ___ in MS patients.
fatigue
70
MOA of alemtuzumab
anti-CD52 drug that inhibits lymphocytes and deters progression of MS
71
MOA of ocrelizumab
anti-CD20 drug for MS
72
what are three oral medications used in MS?
- dimethyl fumarate
- fingolimod
- teriflunomide
73
All patients with memory loss must have which tests?
- Head CT
- B12
- TSH
- VDRL or RPR
74
WHat does a head CT scan show with a patient with alzheimer's disease?
- diffuse, symmetrical atrophy
75
What are first line treatment options for alzheimer's dementia?
- anticholinesterase drugs, such as donepezil, rivastigmine, and galantamine
76
define alzheimer's disease
- progressive memory loss in patients exclusively >65 y/o
| - patients will eventually develop apathy and imprecise speech
77
What are the two physical methods of preventing falls in the elderly?
- strength training
| - exercise
78
What does a head CT scan show with a patient with pick disease (frontotemporal dementia)?
- focal atrophy of the frontal and temporal lobes
79
How will a patient with Pick Disease present?
- personality and behavioral changes occur first
| - followed by memory loss
80
Tx for Pick Disease
- anticholinesterase medications "stigmines"
81
What are the diagnostic tests for creutzfeldt-jakob disease?
- MRI
- brain biopsy- only if CSF did not show 14-3-3 protein
- EEG
82
define lewy body dementia
parkinson disease + dementia
| - patients will have very vivid, detailed hallucinations
83
What are the three symptoms of normal pressure hydrocephalus?
- wet= urinary incontinence
- wacky= dementia
- wobbly= wide, based gait/ataxia
84
Tx for normal pressure hydrocephalus
placement of a shunt
85
What are the two tests that must be completed to diagnose normal pressure hydrocephalus?
- ct of the head
| - lumbar puncture
86
How will a patient with huntington disease present?
- dementia
- psychiatric disturbances with personality changes
- chorea
- young (far below age for alzheimer's)
87
Inheritance for huntington disease is _____
autosomoal dominant
88
Tx for huntingdon disease
antipsychotics for psychiatric disturbances
| - deutetrabenazine, tetrabenazine, and or valbenazine for the movement issues
89
If a patient with a headache is over 40 for their first episode, has a focal neurological finding, or the headache was sudden or severe, what should be completed first?
- CT of head or MRI
90
What are some triggers for migraines?
- cheese
- caffeine
- menstruation
- OCPs
91
What is the best abortive therapy for migraines?
sumatriptan or ergotamine
92
What are the two contraindications for use of triptan drugs?
- pregnancy
| - coronary disease
93
Patients who cannot have triptans or ergotamine or have status migrainosus, should be given?
a dopamine antagonist, such as prochlorperazine, metoclopramide, chlorpromazine
94
If you have to use a dopamine antagonist for migraine treatment, what other medication should you add to prevent dystonia in the patient?
diphenhydramine
95
Main ADR of dopamine antagonists
QT prolongation
96
What is the criteria for needing prophylactic medication for migraines?
Having 4 or more migraines a month
97
What is first line prophylactic migraine med?
propanolol
98
What are second line prophylactic migraine meds?
- CCBs
- TCAs
- SSRIs
99
Which type of migraine medication class make parkinson disease worse?
anti-dopaminergic
| *dopamine antagonists
100
Why are triptan drugs dangerous in patients with pregnancy or coronary disease?
- not only do they constrict blood vessels in the brain, but they also constrict vessels in the heart, which can provoke cardiac ischemia
101
Presentation of a cluster headache
- unilateral
- redness and tearing of the eye on the same side as the headache
- rhinorrhea
102
tx for cluster headache for abortive therapy
- triptan or 100% oxygen, steroids
103
tx for prophylaxis of cluster headaches
- CCBs, such as verapamil
104
presentation of temporal arteritis
- jaw claudication
| - tenderness of the temporal area
105
What is the most accurate testing for temporal arteritis?
temporal artery biopsy
106
Tx for temporal arteritis
_ if it is suspected, give steroids. DO NOT DELAY treatment.
- Delaying treatment may result in permanent vision loss.
- DO NOT WAIT FOR BIOPSY TO GIVE STEROIDS
107
How does a pseudotumor cerebri present?
- headache with sixth nerve palsy, visual field loss, transiently obscure vision, pulsatile tinnitus
- papilledema
- double vision due to sixth nerve palsy
* usually seen in an obese young woman
108
What is the most accurate test for pseudotumor cerebri?
lumbar puncture
109
Treatment for pseudotumor cerebri?
1st line- weight loss and acetazolamide
| 2nd line- VP shunt and optic nerve sheath fenestration
110
When does intracranial hypotension occur?
due to CSF leak after LP
111
What tests are needed for diagnosis of intracranial hypotension?
MRI and LP with low CSF pressure
112
Tx for intracranial hypotension
blood patch to close off the leak
113
If a CNS infection is suspected, what is the initial step in management?
Perform a LP
114
After performing an LP in a patient suspected of meningitis, what is the next step of management?
get blood cultures and then start empirical antibiotic therapy
115
When is an LP contraindicated?
Presence of papilledema or intracranial hypertension
116
Gram + diplococci is specific for ____ causing meningitis
pneumococcus
117
Gram - diplococci is specific for ____ causing meningitis
Neisseria
118
Gram - pleomorphic coccobacilli is specific for ____ causing meningitis
Haemophilus
119
Gram + bacilli is specific for _____ causing meningitis
listeria
120
CSF will have ____ in cases of bacterial meningitis
elevated protein
121
Glucose levels in CSF with bacterial meningitis will be less than ____
60%
122
What is the empirical treatment with suspected bacterial meningitis? i.e. the CSF has many neutrophils present
start IV ceftriaxone, vancomycin, and steroids
| *empirical treatment before you get the cultures back
123
What is the most accurate diagnostic test for cryptococcal meningitis?
cryptococcal antigen
124
Cryptococcal meningitis is more likely to be in a patient with ___
HIV with CD4 cells <100
125
What is the treatment for cryptococcal meningitis?
amphotericin, 5-flucytosine, and fluconazole
126
When can fluconazole be stopped in a patient with HIV with cryptococcal meningitis?
when the cd4 levels are above 100
127
What are some symptoms of lyme disease?
- joint pain
- 7th cranial nerve palsy
- rash with central clearing
128
What is the most accurate diagnostic test for lyme disease?
- western blot testing of the CSF
129
tx for lyme disease with neurological symptoms
1st line tx for lyme disease without neurological symptoms
IV ceftriaxone- neurological lyme
doxycycline- without neurological symptoms
130
What is the characteristic rash in rocky mountain spotted fever?
starts on the wrists and ankles and moves towards the center of the body
131
tx for rocky mountain spotted fever
doxycycline
132
Presentation of a patient with TB meningitis
- usually an immigrant with a history of lung TB
- symptoms occurred gradually from weeks to months
- coughing, hemoptysis, fever
133
What is the most accurate diagnostic test for TB meningitis?
acid fast culture
134
What is the quickest test to diagnose TB meningitis?
PCR
135
Tx for TB meningitis
- RIPE therapy with steroids
- r= rifampin
- i= isoniazid
- p= pyrazinamide
- e= ethambutol or a fluoroquinolone
136
If listeria is suspected to cause the meningitis, what is the treatment?
- vancomycin, ceftriaxone, and ampicillin
137
A patient has Neisseria meningitis. After initial therapy of ceftriaxone and vancomycin are given, what is the next step in management?
- droplet isolate the patient for 24 hours
| - provide rifampin to close contacts
138
An adolescent with a stiff neck and a petechial rash is suggested of what bacteria as the cause of the meningitis?
Neisseria
139
Who are at an increased risk for listeria meningitis?
- elderly
- neonates
- immunocompromised
- those on steroids
- those with no spleen
140
What are two types of amoeba that can cause meningitis?
- Naegleria fowleri
| - Acanthamoeba
141
Which bone does the amoebas go through to infect the brain?
cribriform plate
142
What is a primary symptom of a patient who has amoebic meningitis?
anosmia
143
How to diagnose amoebic meningitis?
wet mount (will show mobile amoebae)
144
Tx for amoebic meningitis
miltefosine ( second line amphotericin), steroids may help
145
What are the two main symptoms in a patient with encephalitis?
- fever
| - confusion (AMS)
146
What is the best initial diagnostic test for encephalitis?
head ct scan
147
What is the most accurate test for diagnosing encephalitis?
pcr of the csf for hsv and vzv
148
Almost all cases of encephalitis in the USA are caused by ?
herpes simplex virus
149
HSV and VZV encephalitis are treated with?
acyclovir
150
If a patient is resistant to acyclovir, what is the next line of therapy?
foscarnet
151
MOA of acyclovir, valacyclovir, famciclovir, and ganciclovir?
they all inhibit DNA polymerase
152
What is the main difference between acyclovir and foscarnet?
Acyclovir needs to be activated by thymidine kinase- like the other clovir drugs.
Foscarnet does NOT need to be activated by thymidine kinase, which is why it can be used in treatment resistant acyclovir HSV or VZV.
153
Autoimmune encephalitis is treated by?
- IVIG
- steroids
- removal of the teratoma
154
A patient diagnosed with autoimmune encephalitis has what kind of teratoma in their history?
- ovarian
155
What will the CT scan show of a patient with a brain abscess?
- ring enhancing lesion
156
What is the treatment for a brain abscess in a patient who is HIV negative?
- ceftriaxone and metronidazole until cultures come back *empirical tx
157
A patient with a brain abscess who is HIV positive should be suspected of having?
toxoplasmosis gondii
158
A patient suspected of having toxoplasmosis should be empirically treated with?
pyrimethamine and sulfadiazine for two weeks
159
In a patient who is HIV negative but has a brain abscess shown on CT scan, what is the best next step?
brain biopsy
160
What will the head CT scan show in a patient with neurocysticercosis?
multiple 1 cm cystic lesions
161
Uncalcified neurocysticercosis is treated with ?
albendazole and praziquantel
| *and steroids to prevent a reaction from the dying parasites
162
What does an MRI show in a patient with posterior reversible encephalopathy syndrome?
- vasogenic edema in the posterior lobes
163
What can cause posterior reversible encephalopathy syndrome?
- hypertensive crisis
- preeclampsia
- cytotoxic medications, such as cyclosporine
164
How will the CT scan look in a patient with a concussion?
normal
165
how will the CT scan look in a patient with a contusion?
ecchymosis
166
How will the CT scan look in a patient with a subdural hematoma?
crescent shaped collection of blood
167
How will the CT scan look in a patient with an epidural hematoma?
lens shaped collection of blood
168
Tx for large subdural and epidural hematomas
craniotomy for drainage
169
Management of a patient with a large intracranial hemorrhage with mass effect
- need to get the intracranial pressure down--> intubate the patient and hyperventilate them
- decreased the pCO2 to 28-32, which will constrict the cerebral blood vessels
- give mannitol, which helps decrease intracranial pressure
- surgical evacuation to get rid of the hemorrhage
170
When is a PPI required for stress ulcer prophylaxis?
- burn victims
- head trauma victims
- patients who have an endotracheal tube with mechanical ventilation
171
Presentation of a subarachnoid hemorrhage
- loss of consciousness
- focal neurological deficits
- worse headache of the patient's life--> sudden and severe
- photophobia and stiff neck
*presents like meningitis w/O FEVER
172
Blood is an irritant and will bother the stomach and intestines as it is digested. What is the result?
diarrhea with melena
173
Most accurate test of a subarachnoid hemorrhage
lumbar puncture
174
Initial test for suspected SAH
CT head without contrast
175
Tx for SAH
- embolize the site of bleeding
| - prescribe nimodipine to prevent stroke
176
How do you find where the bleed is in a SAH?
angiography
177
Tx for hydrocephalus
ventriculoperitoneal shunt
178
When a patient presents to the ER for a possible stroke, before you send them to get the CT scan of the head w/o contrast, what should you do?
- give something to control the blood pressure, such as labetalol
179
Before you can give tPA to a patient, what 4 tests should you order?
- CBC
- PTT
- PT
- EKG
180
Why is stroke more sensitive to time than any other tissue or organ damage?
Brain tissue has no glycogen stores. The brain almost solely uses glucose for energy.
181
MOA of labetalol
- nonspecific beta blocker (blocks beta 1 and 2), and specific alpha 1 blocker (peripherally)
182
MOA of tPA
- activates plasmin, which cleaves fibrin into d-dimers
183
When a patient comes to the office with suspicion of parkinson disease, what should be tested for on examination?
orthostatic hypotension
* those with parkinson disease when rising from a seated position, their autonomic nervous system takes some time to respond.
* the normal increase in pulse rate and vasoconstriction is not occurring, which then leads to the orthostatic hypotension
184
Patient with parkinson disease is given benzotropine. A couple days later, the patient comes in with dry mouth, urine retention, and abdominal pain. What other symptom should you ask if the patient has experienced?
- memory loss
| * AcH inhibitors decrease memory
185
If amantadine and benzotropine fail in a patient with parkinson disease, what is the next line of therapy?
- ropinirole or pramipexole (dopamine agonists)
186
MOA of carbidopa
inhibits dopamine decarboxylase so that leveodopa stays in the brain longer so that by the time it reaches the blood brain barrier, there is a larger amount crossing over
187
You should not drop a patient's blood pressure more than ___ in the first day at the hospital.
25%
188
What is the cause of a patient losing consciousness with a SAH?
- increased intracranial pressure suddenly decreases CNS perfusion
189
What is the body's natural response to a SAH?
vasospasm
190
What is the most common cause of SAH?
spontaneous rupture of a saccular aneurysm of the circle of willis
191
A patient with Creutzfeld Jakob disease can go from normal to death in how much time?
3-6 months
192
Prions in CJD causes what kind of encephalopathy?
spongiform
193
What is the trinucleotide repeat found in Huntington Disease?
CAG
194
MOA of memantine
NMDA receptor antagonist (N-methyl-D-asparate)
195
What would you expect to find in CSF with a patient with viral meningitis?
- normal or mildly elevated protein
| - elevated WBCs
196
When a patient has meningitis but the cause is unknown, must place patient in ____ because?
- droplet isolation because it may be Neisseria bacteria; take patient out of droplet isolation once you known the cause of the meningitis
197
What class of medication does vancomyocin belong to?
glycopeptide
198
What are the three drugs that are glycopeptides?
- vancomycin
- teicoplanin
- telavancin
199
MOA of vancomycin
Inhibits the backbone polymers of the cell wall of gram + bacteria
200
MOA of macrolides (like azithromycin)
inhibit ribosomes
201
MOA of quinolones
inhibit DNA gyrase
202
Gram stain shows positive cocci in clusters is specific for which bacteria?
Staphylococcus
203
For which organism do steroids give the greatest mortality benefit in those with bacterial meningitis?
pneumococcus
204
What is the most common neurological sequela from meningitis?
hearing loss due to meningitis affecting the 8th cranial nerve
205
Meningitis most affects which part of the brain?
leptomeninges found in the arachnoid space
206
Encephalitis affects what part of the brain?
brain parenchyma
207
What is the mechanism of hydrocephalus developing as a complication of meningitis?
Inflamed arachnoid villi cannot drain CSF
208
A patient becomes red after rapid infusion of vancomycin. Why? and what is the treatment?
- Vancomycin provokes a histamine release from mast cells when infused rapidly.
- Slow the rate down and the red color will go away
209
Main symptom of lumbosacral strain
nontender to touch
210
main symptom of cord compression
tender to touch
211
symptoms of epidural abscess of the spine
tender to touch with fever
212
main symptom of spinal stenosis
pain on walking downhill
213
how does syringomyelia present?
loss of sensation of pain and temp in the upper extremities bilaterally in a cape-like distribution over the neck, shoulders, and down both arms
214
how to diagnose syringomyelia?
MRI
215
Tx for syringomyelia?
surgical
216
What is the most urgent step with a patient with spinal cord compression?
- get the swelling down via steroids
217
How can spinal cord compression present?
bilateral lower extremity weakness, hyperreflexia, and possible bowel and bladder dysfunction
218
A large spinal epidural abscess will be treated via?
surgical decompression
219
When a spinal epidural abscess is suspected, what antibiotics should be given?
Oxacillin or nafcillin to protect against staph infection
220
Which two senses are preserved in an anterior spinal artery infarction?
- position
| - vibratory
221
How does brown-sequard syndrome present?
- ipsilateral position, vibratory sense
- contralateral pain
- temperature
222
What are examples of upper motor neuron injury signs?
- hyperreflexia
- upgoing toes on plantar reflex
- spasticity
- weakness
223
What are examples of lower motor neuron injury signs?
- wasting (atrophy)
- fasciculations
- weakness
224
tx for ALS
riluzole or edaravone (an antioxidant)
225
MOA of riluzole
blocks the accumulation of glutamate
226
Define pseudobulbar affect
form of emotional lability or emotional incontinence characterized by intermittent episodes of laughter and crying
227
Tx for pseudobulbar affect
dextromethorphan with quinidine
228
What is the most common cause of peripheral neuropathy?
diabetes
229
Tx for diabetic neuropathy
gabapentin or pregabalin
| *TCAs can also be used but have a higher ADR profile
230
What is the initial management of carpal tunnel syndrome?
splint
231
When is surgery necessary for carpal tunnel syndrome?
When there is muscle atrophy
232
Radial nerve palsy is aka?
Saturday night palsy
233
How does radial nerve palsy present?
wrist drop
234
Peroneal nerve palsy is usually caused by?
wearing high boots at the back of the knee
235
How will peroneal nerve palsy present?
foot drop
236
How does trigeminal neuralgia present?
excruciating pain in the face with minor contact or touching of the tongue behind the teeth
237
1st line tx for trigeminal neuralgia
carbamazepine
238
How does bells palsy present?
- hemifacial paralysis of the upper and lower halves of the face
- loss of taste of the anterior 2/3 of the tongue
- hyperacusis
- inability to close the eye at night
239
Tx for Bells Palsy
steroids
240
Bells palsy is usually caused from?
viral infection
241
Define reflex sympathetic dystrophy
- aka regional pain syndrome
- seen in patients who have previous injury to the extremity
- burning sensation with light touch
242
1st line tx for reflex sympathetic dystrophy
- pramipexole or ropinirole
243
Restless leg syndrome is associated with which deficiency?
iron
244
What is the most important factor in determining treatment for guillan-barre syndrome?
peak inspiratory pressure
*predicts who will have respiratory failure before it happens
245
What is the presentation of Guillan-Barre syndrome?
- ascending weakness with loss of deep tendon reflexes after having an illness (usually from C.jejuni)
246
What are the characteristics of Miller Fisher Syndrome?
- descending weakness
- ocular/oculomotor palsies
- antibodies against GQ1b
247
How does myasthenia gravis present?
- weakness that progresses as the day goes on
- weakness with mastication
- blurry vision from diplopia
- drooping of eye lids
248
What is the best initial test for myasthenia gravis?
- Anti-ach receptor antibodies
249
If the anti-ach receptor antibodies are negative in a suspected patient with myasthenia gravis, what is the next test to order?
- anti-muscle specific kinase antibodies
250
What is the best initial treatment for myasthenia gravis?
- pyridostigmine or neostigmine
251
Patients with myasthenia gravis on pyridostigmine or neostigmine with ADRs can be placed on ____ to help alleviate ADRs.
- glycopyrrolate
| * helps with drooling and diarrhea
252
What is the treatment with a patient in myasthenia crisis?
- IVIG or plasmaphoresis
253
MOA of azathioprine
decrease t-cell function
254
Presentation of lambert-eaton syndrome
- hyporeflexia
| - weakness that improves with repetitive movements
255
What is the test for lambert-eaton syndrome?
- anti-voltage gated calcium channel antibodies
256
Tx for lambert-eaton syndrome?
- amifampridine or dalfampridine
257
Why would you order a CXR for a patient with myasthenia gravis?
- they may have a thymoma that is causing their symptoms or thymic hyperplasia
258
AcH receptors on muscles are ____
nicotinic
259
AcH receptors in the lung, bladder, bowel, saliva, and eyes are _____
muscarinic
260
What is the most accurate test for myasthenia gravis?
- single fiber electromyography
261
How does plasmaphoresis work in myasthenia gravis?
It removes the antibody that attacks acH receptors.
262
MOA of IVIG in myathenia gravis tx
blocks macrophages that attack AcH receptors
263
If patient is having no improvement with disease progression on an anticholinesterase inhibitor with MG, what is the next step?
thymectomy
264
Patients on cyclosporine should have which function monitored?
renal
265
What does GBS impair?
only muscular exertion; no effect on elastic fibers or the flexibility of the chest wall
266
What is the most accurate test for GBS?
nerve conduction velocity testing
267
WHat is a positive result for GBS on nerve conduction velocity testing?
decreased F-wave transmission
268
What will most likely be found in CSF from LP in a patient with GBS?
high protein with normal cell count
269
What is the mechanism of GBS that causes ascending paralysis?
- antibodies attacking peripheral nerve myelin
270
What are the three characteristics of cushing reflex?
- hypertension
- bradycardia
- increased intracranial pressure
271
What causes a dilated pupil on the site of the intracranial bleed?
- compression of the third cranial nerve
| * dilating the third cranial nerve would cause constriction
272
What is the mechanism that causes a lucid interval in a patient with an intracranial bleed?
- accumulation of blood in the skull decreasing perfusion
| * the accumulation of blood increases intracranial pressure and decreases cerebral perfusion
273
A patient with a suspected intracranial bleed who is having a further worsening change in altered mental status should have what next in their management?
- intubated and hyperventilated
274
What is the beneficial effect in hyperventilating an intracranial bleed?
decreased PCO2 constricts cerebral vessels
| *cerebral vessels are very sensitive to concentrations of CO2
