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[1b] a- step 3 > ✅NEUROLOGY > Flashcards

✅NEUROLOGY Flashcards

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1
Q

Pts with [Dementia with Lewy Bodies (DLB)] are extremely sensitive to _____ and it may cause what side effects?-3

A

DLB at the DMV

ANTIPSYCHOTICS

________________

  • Dementia INC
  • MichaelJFox PARK INC
  • autonomic dysfunction
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2
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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3
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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4
Q

[Dementia with Lewy Bodies (DLB)] Tx- 2

A

1. Rivastigmine AChinesterase inhibitor

  1. [2nd Gen Antipsychotic] for visual hallucination
    * REMEMBER THAT DLB PTS ARE SENSITIVE TO ANTIPSYCHOTICS*
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5
Q

Frontotemporal Pick’s Dementia

Sx -2

A

Prounouced Frontal & Temporal lobe atrophy –>

[Socially inappropriate Behavior] + aphasia

OCCURS MORE IN FEMALES!!!

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6
Q

A: Demographic of Frontotemporal Pick’s Dementia?

B: Mode Of Inheritance

A

A: 50-60 yo Females (Alzheimer = > 60)

B: Auto Dominant

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7
Q

Early Findings of Alzheimer’s - 4

A

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

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8
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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9
Q

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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10
Q

Normal Pressure Hydrocephalus characteristics - 4

A

Wacky, Wobbly & Wet!

  1. Idiopathic
  2. Episodic
  3. Elderly
  4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

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11
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> β-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from β-amyloid deposition in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation –> defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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12
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> β-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from β-amyloid deposition in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation –> defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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13
Q

Late Findings of Alzheimer’s - 5

A

CLAV –> HANDU

Hallucinations

Agnosia (unable to recognize things via 5 senses)

Neuro ∆ (seizure/myoclonus)

Dyspraxia (unable to do things from before)

Urinary Incontinence

Onsets after 60 yo

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14
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
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15
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
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16
Q

Late Findings of Alzheimer’s - 5

A

CLAV –> HANDU

Hallucinations

Agnosia (unable to recognize things via 5 senses)

Neuro ∆ (seizure/myoclonus)

Dyspraxia (unable to do things from before)

Urinary Incontinence

Onsets after 60 yo

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17
Q

Normal Pressure Hydrocephalus characteristics - 4

A

Wacky, Wobbly & Wet!

  1. Idiopathic
  2. Episodic
  3. Elderly
  4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

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18
Q

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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19
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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20
Q

Early Findings of Alzheimer’s - 4

A

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

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26
Q

Memantine MOA ; Indication

Study These Flashcards
A

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer’s

27
Q

Memantine MOA ; Indication

Study These Flashcards
A

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer’s

28
Q

Name the Major UMN signs (5)

Study These Flashcards
A

UMN signs = Weak MESH

Weakness

[Spastic Gait & Paralysis] (partially from disproportionate Extensor weakness)

[Exaggerated Reflexes (Babinski)]

Mental Status change

HemipLegia

29
Q

Parkinsonism Clinical signs (8)

Study These Flashcards
A

PARK & hamp

[Pill Rolling Resting 4-6 Hz unilateral Tremor] worst with Rest & Mental Task

[Rigidity Cogwheel]

BradyKinesia

[AReflexia posturally] –>Shuffling Gait/Fall when turning or stopping

+

  • hypOphonic speech
  • Autonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension)
  • micrographia
  • poker masked face
  • PARK = primary signs*
31
3 Main causes of Spinal Cord Compression
1. **DJD Disc Herniation** (Smoking risk factor) 2. [Epidural Staph a. Abscess (think IV drug user vs DM)] 3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets) ## Footnote Dx = MRI, Positive Straight Leg, Classic S/S *DJD=Degenerative Joint Disease*
32
Etx of Parkinsons Disease
[**LABS** (**L**ewy **α****-**synuclein**B**odie**S**)] accumulation in [substantia nigra pars compacta] --\>degeneration --\> ⬇︎Dopamine release and ⬇︎ stimulation of Striatum which --\> allows Globus pallidus internal to continuously inhibit [VA/VL Thalamus from stimulating motor cortex]
33
Where are Brain Metastasis typically found? - 2
Gray White Junction vs Watershed Zones ## Footnote * Brain metastases are multifocal and spherical* * Most common= [LUNG NonSOLC] \> Breast/Colon/Kidney/Melanoma*
34
Name the Lower Motor Neuron signs - 4
LMN signs (**FAAW**) - **F**asciculations / **A**trophy & **A**reflexia / **W**eakness
35
Bromocriptine MOA ; Indication
Dopamine PostSynaptic R Agonist ; Parkinson's
36
Parkinsonism is often caused by ____ or \_\_\_\_\_ Name 2 *rare* causes of Parkinsonism
Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs] rare = Toxic levels of CO2 or ManGanese **PARK** & **hamp**
40
Name the 3 components of **EPS**-**E**xtra**P**yramidal**S**ymptoms
EPS = **DAD** [**D**rug-induced Parkinsonism] **A**kathisia (restlessness) **D**ystonia (sudden twisted posture worst with activity) *Tx = Benztropine vs Diphenhydramine*
41
Parkinson's Dz Tx - 6
"Eat **SALADS** after you Park" ## Footnote 1. [**L**evodopa (Dopamine Precursor) + Carbidopa] 2. **A**mantidine 3. **A**nticholinergics 4. [**D**opamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine) 5. **S**elegiline 6. **S**urgery - Pallidotomy: Destructive of [Globus Pallidus:internal] - SubThalamic nuc. inhibition with electrode - ANT Choroidal a ligation
42
How is [Brain Death] diagnosed? -4
1. Brainstem functions ABSENT (pupil, pain response, gag, corneal) 2. CORTEX functions ABSENT 3. Spinal Cord (Deep Tendon Reflex) are +/- 4. **APNEA TEST FOR CONFIRMATION**
43
**Serotonin Syndrome** Clinical Presentation (8)
"Serotonin gave me the **SHIVERS**!" ***S**hivering* [**H**yperreflexia & Myoclonus] **I**NC Temp *[**V**itals instability] (tachycardia vs. tachypnea vs. HTN)* ***E**ncephalopathy (Confusion vs. Agitation)* **R**estlessness **S**weating *Italicized = Triad Sx*
44
How do you treat *Refractory* Serotonin Syndrome
Cyproheptadine (antihistamine with anti-serotonergic properties)
45
Describe Neuroleptic Malignant Syndrome - 5
RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that --\> **FEVER** - [**F**ever \> 40C] - **E**ncephalopathy (Confusion) - **V**itals unstable (INC HR / RR / BP from autonomic dysfunction) - **E**nzymes ⬆︎ (CPK) - [**R**igitidy lead pipe] (Tremor)
46
What's the best way to approach treatment for [Neuroleptic Malignant Syndrome]-2
Treat [Rigiditiy lead pipe] with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum) + supportive care
47
Why does Fluoxetine need __ weeks to washout before starting a MAOI?
5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SSRI + MAOI ➜ SEROTONIN SYNDRONE *(SHIVERS)*
48
Name the Serotonergic Drugs -5
1. SSRI 2. SNRI 3. TriCyclic Antidepressants 4. Tramadol 5. MDMA
49
Which 2 drugs are contraindicated with Serotonergic drugs?
- MAOI - Linezolid
50
Sciatica etx ; Clinical Presentation - 3
"Having Sciatica makes you break **LAWS**" * [**L**ower Back pain w/radiation down POSTERIOR thigh --\> lateral foot] * **A**nkle jerk reflex ABSENT (this can occur naturally with age!) * **W**eak Hip Extension * [**S**1 n PosteroLateral compression at L4-5 or L5-S1] --\> UMN signs
51
Sciatica tx ; dx?
"Having Sciatica makes you break **LAWS**" NSAIDs + APAP = 1st line as Sciatica sx are self limited Dx = **CLINICAL** (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)
52
What is the femoral nerve responsible for? -5
1. MOTOR EXTENDS KNEE 2. REFLEX Knee Jerk 3. SENSORY Anteromedial thigh 4. SENSORY medial lower leg 5. SENSORY arch of foot
53
Most common [1° CNS Tumors] in Adults (3)
**GMS** **G**lioblastoma astrocytoma (GRADE 4 - MALIGNANT - 2nd MOST COMMON to Metastasis) **M**eninGioma benign **S**ChWannoma *Brain Metastasis=MOST COMMON ADULT BRAIN CA*
54
List the n. roots associated with Common Peroneal n.
L4-S2 foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes) * Commonly caused by L**5** Radiculopathy* * Dx: Knee MRI vs EMG*
55
List the n. roots associated with Tibial n.
L4-S3 (**T**hree) can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes) *Commonly caused by L5 Radiculopathy*
56
Most common [1° CNS Tumors] in Pediatrics-3 ; what's the only one that's supratentorial?
**PED**s **P**ilocytic Astrocytoma = MOST COMMON and can be Supratentorial OR infratentorial **E**pendymoma (found in 4th Vt) me**D**ulloblastoma PNET = 2nd most common ***E**pendymoma and me**D**ulloblastoma are infratentorial POST fossa(image)*
57
List the n. roots associated with Common Peroneal n.
L4-S2 foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes) * Commonly caused by L**5** Radiculopathy* * Dx: Knee MRI vs EMG*
58
What are the functions of the Common Peroneal n. -2
L4-S2 foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes) * Commonly caused by L**5** Radiculopathy* * Dx: Knee MRI vs EMG*
59
List the n. roots associated with Tibial n.
L4-S3 (**T**hree) can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes) *Commonly caused by L5 Radiculopathy*
60
List the n. roots associated with Tibial n.
L4-S3 (**T**hree) can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes) *Commonly caused by L5 Radiculopathy*
61
Functions of the Obturator n.-2
1. MOTOR Leg ADDuction 2. SENSORY medial thigh \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *usually from pelvic trauma or surgery*

[1b] a- step 3 (16 decks)

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