Neurology Flashcards
(160 cards)
1
Q
What is CT scan? When is it used?
A
produces XR similar to conventional XR but produces cross sectional images without superimposing tissues on each other - used in trauma situations due to speed and superiority over plain film
used in initial CVA/neuro studies but NOT preferred over MRI
fat is black on a CT scan (vs white on MRI)
2
Q
What is SPECT? When is it used?
A
Single position emission CT; function CT scan of the brain
used in dx of dementia
3
Q
What is unique about a PET scan?
A
reveals the cellular level metabolic changes occuring in an organ/tissue (important bc this is where disease proceses often begin; earlier detection)
4
Q
imaging of choice for nervous system
A
MRI
5
Q
what is the procedure of choice in CNS diagnosis?
A
Imaging (MRI) except in cases of meningitis > lumbar puncture
6
Q
Low Ach =
A
decreased memory, delirium, delusions
7
Q
high ach =
A
aggression, depression
8
Q
low dopamine =
A
dementia, movement disorders, depression
9
Q
high dopamine =
A
psychoses, anxiety, confusion, aggression
10
Q
low norepi =
A
depression, dementia
11
Q
low GABA =
A
anxiety
12
Q
high GABA =
A
affective decrease, lethargy
13
Q
low glycine =
A
anxiety
14
Q
high glycine =
A
affective decrease, lethargy
15
Q
low NO =
A
vasospasm, potential hyperactivity
16
Q
high NO =
A
sedation, vasodilation, visual hallucinations
17
Q
low histamine =
A
depression
18
Q
high histamine =
A
mania
19
Q
“Downers” (neurotransmitters)
A
GABA
glycine
NO
histamine (special instances)
neurosteroids
20
Q
“uppers” (neurotransmitters)
A
serotonin
ach
dopamine
NE
histamine
glycine (special instances)
21
Q
neuroleptic MOA and classes
A
dopamine blocking
phenothiazine
benzisoxazole (respiradone)
butyrophenon (haloperidol)
dibenzodazepine (clozapine, quetiapine)
thienebenzodiazepine
22
Q
adverse effects of neuroleptics/antipsychotics
A
tremors/parkinsonian effects
spasms/movements you cant control
tardive dyskinease
POTS
blurred vision, dry mouth, constipation, urinary retention
sexual dysfunction
drowsiness
23
Q
what is neuroleptic malignant syndrome? how does it present, and what is the tx?
A
too much neuroleptic drug; catatonia, fluctuating BP, dysarthria, and fever
fatal unless antipsychotic immediately discontinued and tx with dopamine agonist such as bromocriptine
24
Q
If you are looking at doing AA therapy with somebody, what is an important consideration?
A
make sure their B vitamin/mineral cofactor levels are at proper level
25
supplement for concentration/cognitive support
phosphatidylcholine - donates choline for ach syntehesis
26
supplement for sleep-wake regulation
phosphatidylserine - donates choline, supports dopamine production
27
supplement for serotonin affected syndromes
phosphatidylinositol - sensitizes serotonin receptors
28
NT therapy for the tx of depression
catecholamine therapy (need uppers)
serotonin therapy (need leveling)
combination?
29
NT therapy for the tx of anxiety/sleep/seizure/mania
GABA
glycine
NMDA antagonist
NO
histamine
30
supplements for depression
SAMe
phenylalanine
tyrosine
(inc dopamine and norepi)
31
what nutrients are precursors for catacholeamines and should be avoided if someone is on a dopamine reuptake inhibitor?
tyrosine
phenylalanine
32
reuptake of dopamine is blocked by:
cocaine
buproprion
benzatropine
amphetamine
33
norepi reuptake is blocked by
tricyclics
amphetamine
34
serotonin comes from the breakdown of ____
tryptophan >
> serotonin > melatonin
> niacinamide (low niacin might steal tryptophan for its pathway)
35
serotonin is degraded by
MOA
aldehyde dehydrogenase
36
what is key for SSRI lowering/removing?
tryptophan and cofactors (B3, iron, B5, B6, B12, folate)
taper drug almost all the way/fully first before adding nutrients
37
signs/sx of serotonin syndrome
fever
hyperreflexia
BP changes
coma
death
38
tricyclic drugs MOA
"combinations" catecholamines AND serotonin
39
tricylcic discontinuation considerations
watch for rebound insomnia, replace NE and 5HT with SLOW tapering
40
drugs for depression and central pain
citalopram (SSRI)
escitalopram (SSRI)
duloxetine (SSNRI)
41
drugs for fibromyalgia
mostly antidepressants raising serotonin, NE, DOPA, or all three
one is an atypical anti-seizure med
42
histamine effects in the brain
H1 (stimulating)
H2 (stimulating)
H3 (inhibiting)
H4 (inhibiting)
so h1/h2 blockers can produce somnelesence > used for insomnia
43
3 Bs of GABA reception
booze
barbiturates
benzodiazepines
GABA overdose
44
GABA comes from ____
glutamine
glutamine > GABA (relaxing)
glutamine > glutamate (stimulating)
45
inhibitory activity of the CNS is caused by
chloride channel opening (by GABA or glycine)
46
why is progesterone considered a neurosteroid?
binds to GABA receptor
47
what is the class effect of barbituates/benzos?
amnesia (faster hits ur brain = more amnesia)
48
what is an anxiety drug with no GABA effect/addictive qualities?
buspirone
49
there is a need for extreme caution in patients with what dx in glycine supplementation?
bipolar; potential NMDA (glutamate) receptor triggering > mania
50
excitatory action NMDA receptors
- glycine (in some cases)
- glutamate
- zinc
51
how to dx epilepsy
can NOT dx with secondary seizure cause (tumors, organic dz, etc)
MRI image of choice, LP may be done in some cases
52
simple partial seizure
limited to single part of body/one aspect of bx
consciousness preserved
focal motor (convulsive jerks) or somatosensory (paresthesia or tingling)
53
jacksonian seizure
spread to "march" to diff parts of limb to body
sensory sx (light flashes, smells, buzzing, songs)
autonomic sx (flushing, sweating, epigastric sensations)
54
complex partial seizure
s/s may change during attach (hallucinations > complex motor acts)
change in or loss of consciousness
deja vu, fear, pleasure, anger
can lead to tonic-clonic/complete seizure
55
generalized seizures
may evolve from partial seizures
paroxysmal neuronal d/c generalized to both sides of the brain
usually has alteration or LOC
two major kinds - absence (petit mal) and tonic clonic (grand mal)
56
absence (petit mal) seizures
begin 2-12
+ fhx
two types: simple absence (1-2 sec, blank stare, spacing out), complex absence (15-30 sec, head drops, arms jerk, every 10-100 days, hyperventilating can trigger > can lead to grand mal as adults)
57
tonic clonic (grand mal)
most extreme, can begin at any age
triggered by fatigue, fever, low Ca, glucose, magnesium
may be preceded by prodrome of mood change, apprehension, loss of appetite
tonic (10-20 sec) body stiff/arch, cyanotic
clonic (series of jerks, loss of sphincter control, bite tongue)
post ichtal - flaccid relaxation, heavy breathing/salivating
> wake up, sleep for several hours, start new convulsion (status epilepticus)
58
what is an important dietary consideration for a pt on lithium?
NEVER low sodium diets! lithium interferes with sodium ions in the brain (and rest of body)
59
common long term kidney adverse effects
kidney dz
hypothyroidism
60
what nutrient used with ritalin improves ADHD sx control in children?
zinc
61
bacterial meningitis etiology, presentation
e coli, h flu, meningococcus
HA with photophobia
purpuric rash on trunk, fever
nuchal rigidity (not always in peds/neonates)
obtundation (dec alertness)
toxic appearance
62
most common organisms and tx for meningitis in ages: 0-4 weeks
group B strep, e coli, listeria
ampicillin + cefotaxime
63
most common organisms and tx for meningitis in ages: 4-12 weeks
strep pneumo, group B strep, e coli, listeria
ampicillin, third generation cephalosporin
64
most common organisms and tx for meningitis in ages: 3 mo-18 years
s pneumo, n meningitidis, h flu
third gen cephalosporins
65
most common organisms and tx for meningitis in ages: 15 years-50 years
s pneumo, n meningitis
third generation cephalosporin
66
most common organisms and tx for meningitis in ages: >50 years
s pneumo, n meningitis, listeria, aerobic gram - bacilli
third generation cephalosporin + ampicillin
67
encephalitis presentation and etiology
severe: HA with systemic sx, focal neuro deficit
sub acute: similar to severe viral illness, HA persists as systemic sx wax and wane
viral: CMV, HIV, polio, rabies
bacterial: listeria, TB, syph, rickettsia, toxoplasma gondii
EEE (togaviridae) from bird as reservoir (ppl and horses get the disease)
MMR/chicken pox > AI encephalitis
HSV 1+2
68
what sign/sx can differentiate between meningitis and encephalitis?
focal neuro deficit present in encephalitis
69
presentation rabies
dog or wild carnivore bite
negri bodies in hippocampus and cerebellum
paresthesias around wound, spasms, hydrophobia
respiratory failure
70
presentation poliomyelitis
non specific gastroenteritis - **flaccid paralysis**, hyporeflexia, secondary invasion of LMN
post polio syndrome - progressive weakness 25-35 years later, muscle wasting, pain, virus not found
71
what ddx can commonly be mistaken for vertebral back pain?
herpes zoster recurrence
72
bells palsy etiology, presentation, tx
unilateral facial paralysis of sudden onset
usu viral infxn with swelling CN7 (facial)
pain behind ear may precede paralysis
no sensory loss, except taste
tx: difficult; steroids, PT, eye patching to prevent keratitis, B12, hypericum, acyclovir if viral
73
guillian barre synrome presentation
follows flu/recent viral infxn
symmetric weakness with paresthesias, beginning in legs and moving upward (most reach max paralysis in 2-3 weeks), half have facial involvement
DTRs lost, sphincter control maintained
inc CSF protein
generally self limited; supportive care
ddx: botulism
74
botulism presentation
**descending flaccid paralysis **
dry mouth, diplopia, ptosis, loss of accomodation and pupillary light reflex
GI sx precede > N/V, cramps, diarrhea
NO FEVER
75
how may infant botulism present differently?
most often seen at 2-3 months
caused by colonization of gut (honey, soil, spore contaminated foods)
constipation may preceded other sx
may progress to "flobby baby"
stool analysis confirms dx
76
where do brain/CNS tumors tend to occur?
in adults - ABOVE tentorium cerebelli
in children - BELOW
77
astrocytoma presentation and grading
usu involves frontal lobe in adults, cerebellum in children
recent/worsening HA, N/V, altered mental status, visual disturbances, lack of coordination/sensation
grade 1-2: benign
grade 3: malignant
grade 4: glioblastoma multiforme - AGGRESSIVE, MALIGNANT
78
what is the most common primary brain tumor in adults?
glioblastoma multiforme (grade 4 astrocytoma)
79
peripheral nerve tumors
schwannomas: benign
acoustic neuroma: CN 8 (severe vertigo)
neurofibromas: benign if solitary
neurofibromastosis = von recklinghausens, AD & mutations
80
wernicke korsakoff syndrom
thiamine (b1) def due to alcoholism
confabulations, no short term memory
typically reverses with IV B1
81
pellegra
niacin/b3 def
dementia, dermatitis, diarrhea (death)
82
b12 def
macrocytic anemia
degeneration of spinal cord (spasticity, weakness, dementia, loss of proprioception)
NOT cured by folate supplementation, tho the anemia will clear
83
key points of ischemic cerebrovascular dz/stroke
new recurrent, nondescript HA often occur before event: new HA in pts > 50 should be investigated
84
signs of increased ICP
papilledema (swelling of disk) and brain herniation
85
cerebral edema
brain has no lymphatics, BBB controls fluid transport
edema secondary to inc vascular permeability, altered regulation of fluid or transudation
common after injury, radiation, long term HTN
86
hydrocephalus
enlarged ventricles
inc CSF produced in choroid plexus
lateral third and fourth ventricles swell
87
what type of necrosis occurs in cerebral infarction/stroke?
liquifaction necrosis
88
most common arteries to be affected in stroke
middle cerebral arteries
89
intracranial hemorrhage
HTN, rupture of aneurysms (charcot bouchard)
confusion, drowsiness, HA, nausea
90
vascular malformations in the brain
AVM = congenital, anywhere, chronic HA, hemorrhage, seizures, neuro deficit
cerebral:
- berry = most common; congenital, ant middle and post communicating arteries; sudden excruciating HA with rupture **"worst ha of my life"**
- fusiform (atherosclerotic)
- mycotic: sec to staph/strep
91
hypertensive encephalopathy
DP > 120
grade 4 retinal changes
confusion, drowsiness, HA, nausea
may lead to rupture and hemorrhage
92
CNS vascular compromise
various neuro deficits
often from vascular compression (tumors, acute disk compression)
occlusion from remote causes (aortic surgery, dissecting aneruysm)
93
time frame that TIA and RIND affect pt
TIA: sx/signs of stroke <24 hours
RIND: sx/signs of stroke >24 hr BUT RESOLVE COMPLETELY
94
most common presentation of TIA
acute onset, last 2-30 min
no permanent sequelae
90% affect carotid > ipsilateral blindness, CL hemiparesis
neuro exam normal
95
type of stroke with: speech not impaired
right cortical stroke
96
type of stroke with: impaired attention
corticol stroke
97
type of stroke with: impaired cognition
large cortical or bilateral stroke
98
type of stroke with: total hemiplegia
sub cortical stroke
99
type of stroke with: lower CN involved
sub cortical stroke
100
type of stroke with: cerebellar signs
sub cortical stroke
101
what could be a non-typical presenting sx of stroke?
seizures
personality change
102
what is unique bx to a cluster headache?
restless behavior (evil lil gnome hitting u with hammer..taking break...hitting again - bc they know pain is coming but dont know when so they are extremely agitated)
103
ddx of headache as a sign
infectious (encephalitis, meningitis)
brain tumors
eye
sinus
vascular (AVM, aneurism, HTN, giant cell arteritis)
cluster, tension, migraine
trigeminal neuralgia
104
migraine tx
goal is vasoconstriction
triptans are specific 5HT effectors
ergot drugs are alpha effectors
105
consideration for triptans
highest action in basilar artery
CI in basilar artery migraine (comes from base of skull, radiates upwards) > can cause rupture (inoperable death sentence)
106
important finding in trigeminal neuralgia to differentiate it from more serious causes
no sensory loss or motor weakness
107
giant cell/temporal arteritis presentation and tx
malaise, proximal muscle pain, jaw claudication, tender scalp arteries, unilateral HA
untreated > blindness in 50% of those who present with HA (from opthlamic branch)
ESR 100+ biopsy of artery
tx: immediate steroids
108
first ddx of someone waking up in the morning with a headache
carbon monoxide poisoning
109
DEA control of pain meds
- central muscle relaxants - nonDEA
- central pain control - DEA and non DEA scheduled
- peripheral pain control (NSAIDS, steroids) - non DEA scheduled
110
MOA muscle relaxants
work on proprioception; drive to have muscle contraction (why overdose can lead to respiratory depression)
111
all opiates share what SE?
PSLYTIC activity
constipation, N/V, rebound insomnia
itching
overdose = death from respiratory distress
112
MOA opiates
central (kappa / mu)
disassociation from pain
113
naloxone vs naltrexone
naloxone (IV) = EMS opiod overdose tx
naltrexone = same but also used orally low dose in CA and AI
114
adult dose threshold acetominophen
4 g / 24 hours
#1 overdose/toxicity in the world
toxicity = hepatotoxic necrosis (etoh inc hepatotoxicity at 3 drinks/day)
no dialysis/way to get out of system. NAC assists in excretion.
115
acetominophen MOA
hypothalmic pain threshold
116
peripheral pain control
shut down cytokines
NSAIDS, steroids, gout meds
117
main SE aspirin
salycism (severe vertigo); tinnitus, hearing loss
118
whats a risk in IV NSAIDS that is more of a long term risk in oral?
kidney damage
119
dose calculations b/w prednisone and cortisone
prednisone:cortisone = 4:1
(5 mg prenisone = 20 mg prednisone)
120
physiologic cortisone dose
25-40 mg orally
121
MS etiology, presentation, workup
chronic remitting dz with demyelination of patches in the brain and spinal cord > multiple neuro sx
glove and stocking paresthesias
onset between 20 and 40
weakness, numbness, tingling, unsteadiness, spasticity, diplopia, sphincter disturbance, chronic recurrent optic neuritis
MRI to show plaques (paraventricular white matter lesions)
122
dx in muscular dystrophy
muscle biopsy
123
cerebral palsy
motor manifestations of nonprogressive brain damage sustained during prenatal/postnatal life (low birth weight, anoxia at birth)
spastic; quadraplegic, hemiplegic, diplegic
124
ALS
progressive degeneration of corticospinal tracts and/or anterior horn cells and/or bulbar motor nuclei; mut on chromo 21
both upper AND lower neuron dysfunction
mid and later life; progressive; most die in 3-6 years (respiratory failure)
125
myasthenia gravis
AI disorder caused by ab to ACh receptor of skeletal muscle
women in 20s, men in 40s-50s
weakness (starts in face, head, neck)
**weakness on exertion that is progressive!**
no sensory loss
126
what is the most common movement disorder?
benign essential tumor
fhx
inc with skilled movements (esp with hands) and with tension/stress
absent at rest
**tremor of head and voice**
127
parkinsons
dec dopamine; slowly progressive degenerative dz of CNS
- slow movement (bradykinesia)
- muscular rigidity (affects the face; mask like features), diff initiating movements
- **resting tremor**/pill rolling tremor (dis with sleep, worse w excitement/fatigue)
- postural instability (shuffling gait, no arm swing)
128
huntingtons
AD; dec GABA; manifests in 3rd/4th decade
starts as fidgeting or restlessness > writhing, purposeless movements/ hyperactive DTRs > dementia > death in 15-20 years
129
alzheimers
diffuse cotical atrophy, neurofibrillary tangles
senile plaques in cortex (abnormal tau protein in nerve processes, microglia, and astrocytes)
progressive impairment of higher intellectual function
MUST rule out other causes of dementia; blood sugar, sleep deprivation, etc...
130
dx criteria alzheimers
clinical exam and MMSE (deficits in 2+ areas)
SPECT scanning
progressive worsening
no disturbance of consciousness
absence of systemic or other brain dz to acct for sx
131
use of MMSE
dx / follow mental deficit disorders (such as alzheimers)
graded by education level
132
what NT is central for memory
Ach
for more Ach/chole sparing agents
-inhibit ach esterase (keep it from breaking down, stay in neural synapse)
133
supplement for memory
phosphatidylcholine
134
first step in workup for syncope
EKG; esp to rule out silent heart block
135
very common cause of syncope
too much HTN meds/meds with alcohol
136
NT MOA cannabis
dopamine is released: more neuro activity
anti-inhibition of GABA neurons: more relaxed
137
cocaine MOA
blocks reuptake of
dopamine (euphoria)
serotonin (confidence)
norepi (energy)
138
ecstasy MOA
potentiates norepi and dopamine
STRONG affinity for serotonin transporters (more serotonin = more break from reality)
139
acoustic neuroma presentation/workup
benign primary intracranial tumor of myelin forming cells
U/L hearing loss, tinnitus, disequilibrium
workup: MRI
140
meningioma presentation
raised intracranial pressure > papilledema, CN dysfunction
141
workup and tx for herpes zoster
Tzanck test to see multinucleated giant cells
acyclovir/valacyclovir before rash
gabapentin for post herpetic neuralgia
142
tx rabies
passive immun with human rabies IG into wound site
active imm with killed rabies virus vaccine
143
bacteria causing tetanus
clostridium tetani
144
tx cluster HA
oxygen, sumatriptan
145
tx migraine
triptans
NSAIDs
aspirin
146
triptans are CI in what pathology
basilar artery migraines
147
tx tension HAs
heat, massage, analgesics, TCAs
148
workup and tx TMJ disorder
MRI to look for articular disk placement
NSAIDs, benzodiazepines, moist heat, massage
149
tx trigeminal neuralgia
carbamazepine
150
seizure tx
EMS
high conc O2
roll on side
check glucose
give glucose
IV with ringers/NS
diazepam IV > phenytoin IV
151
tx huntingtons
diazepam + risperidone for chorea
bupropion and TCAs
152
MS tx
INF-B
methotrexate
benzos
TCA
carbamazepine
gabapentin
amantadine
modafinil
153
parkinson tx
amantidine
rivastigmine
levodopa
carbidopa
bromocriptine
pramipexole
scopolamine
154
schizophrenia criteria A that distinguishes it from delusions
2+ of the following over one month
- delusions
- hallucinations
- disorganized speech
- grossly disorganized catatonic bx
- negative sx (lack of affect, alogia, avolition)
rule out other mood, medical disorders
155
tx schizophrenia
risperdal
antipsychotics
anxiolytics
156
bipolar disorder tx
lamotrigine
lithium
quetiapine
157
GAD tx
short term benzos
SSRIs
TCAS
BB
158
OCD tx
SSRIs (fluoxetine, higher doses and longer duration)
atypical and typical antipsychotics
159
what meds to avoid with phobias
TCAs like amitripyline
160
tx PTSD
SSRIs (fluoxetine)
benzos
atypical antipsych (risperidone)
sedatives
hypnotics
