Neurology 2 Flashcards
(99 cards)
1
Q
Atonic seizures clinical features
A
Falling down + no warning signs + brief loss of consciousness + deny loss of consciousness
2
Q
Preferred study for vascular imaging in TIA
A
Carotid duplex US
3
Q
AED for patients with osteoporosis
A
Lamotrigine (others induce p450 system, which increases breakdown of vitamin D)
4
Q
Contraindications for using donepezil or acetylcholinesterase inhibitors for dementia
A
Sick sinus syndrome, LBBB, *asthma, angle closure glaucoma
*ulcer disease
5
Q
Med to use for dementia if patient has contraindication to donepezil
A
Memantine
6
Q
progressive supranuclear palsy clinical features
A
Stu walking across the room + sitting on taxi + eyes looking down to the floor + business executive by window/presentation = rapidly progressive gait dysfunction and falls + executive function loss + vertical gaze palsy (inability to move eyes up, called Parinaud syndrome).
Location: Jacquie Carrico’s apartment
7
Q
Treatment of trichotillomania
A
SSRIs
8
Q
How to differentiate etiology of cranial nerve 3 palsy
A
Parasympathetic fibers run on outside (compression), which leads to mydriasis (down and out blown pupil with aneurysm) → With DM2 it will be down and out without mydriasis
9
Q
Myasthenia gravis clinical features
A
Moon astronaut walking extremely slowly and sluggishly and ACTH is painted on the rocket ship + he’s four eyed/worsening fatigue + difficulty opening eyes + diplopia.
10
Q
Myasthenia gravis treatment
A
There are huge pyramids on the moon/Pyridostigmine is first line (acetylcholinesterase inhibitor). /Thymectomy is first line.
11
Q
Cranial nerve 3 palsy presentation
A
- pupil blown down and out
- ptosis
(Confirm)
12
Q
medication-overuse headache (MOH) clinical features
A
- patient taking daily analgesics (NSAID, triptans, opiates, butalbital) and headache getting worse (defined us using greater than 15 days out of the month)
13
Q
treatment of medication-overuse headache (MOH)
A
- immediately discontinue offending analgesic agent
- bridging agent (typically have worsening after med discontinuation so need short 1-2 week steroid course to control HA)
14
Q
Clinical features of idiopathic intracranial hypertension
A
- vision changes
- chronic daily HA
- worsening when lying flat
- MRI abnormalities (posterior scleral flattening, empty sella)
15
Q
Imaging features of metastatic brain tumors
A
- located at gray-white matter junction
- multiple
- large vasogenic edema
- circumscribed margins
16
Q
Cerebral amyloid angiopathy clinical features
A
elderly patient + multiple lobar hemorrhages
17
Q
clinical features of intracerebral hemorrhage from AVMs
A
- usually younger people (10-40) + hemorrhage extending into ventricles or subarachnoid space (not limited to lobar area)
18
Q
Rupture berry aneurysm clinical features
A
- sudden onset of severe headache + confusion + occasionally fever + *nuchal rigidity
19
Q
treatment of otitis externa
A
- remove debris
- topical antibiotic (*quinolone)
- topical steroid
20
Q
Management of refractory otitis externa
A
- culture ear canal + refer to ENT
21
Q
outpatient CAP therapy
A
IF no comorbid conditions – augmentin OR doxy
IF comorbid conditions (DM2) or recent abx use or hx of drug-resistant strep pneumo –> beta-lactam antibiotic + macrolide OR quinolone
22
Q
Determining dispo for pneumonia
A
- CURB-65 (admit if 1 or more) Confusion Urea (greater than 20) Respirations (greater than 30) Blood pressure Age over 65
23
Q
bulimia treatment
A
- SSRI
- nutritional rehab
- CBT
24
Q
Indications for valve replacement with MR
A
- symptomatic
- EF less than 60%
- end systolic dimension greater than 40
- pTHN or new onset AF
- NOT moderate atrial dilation
25
mononeuritis multiplex clinical features
- asymmetric + multiple peripheral neuropathies (sensory and motor) + painful
- typically in patients with underlying vasculitis, connective tissue disease, or systemic disorders (DM2)
- steppage gait or wrist drop
26
treatment of mononeuritis multiplex
- treat primary disease process
27
Other MS clinical features
- usually starts before age 50
| - NO affect on peripheral nervous system (thus no polyneuropathy)
28
how to reduce incidence of central line infections
- daily chlorhexidine baths (skin disinfection)
- antibiotic-impregnated catheters
- never use guide wire technique to replace
29
Highest risk central lines for infection
femoral highest, IJ second highest, subclavian least likely
30
Management of patient with lyme disease with persistent symptoms after treatment
- this is "post-lyme disease syndrome"
| - no further management, just supportive care
31
WPW ECG
Short PR interval + delta wave + widened QRS
32
WPW clinical features
young patient + often asymptomatic + occasional symptomatic SVT (manifesting as palpitations, lightheadedness, presyncope or syncope, chest pain, or SCD)
33
Most commonly associated SVT with WPW
AVNRT (regular and narrow complex)
34
when to admit TIA patients
- RF's (multiple recurrent TIAs, AF, symptom duration over an hour, hypercoagulopathy, symptomatic internal carotid artery stenosis over 50%)
- high ABCD2 score (predicts risk of stroke within next 48 hours)
35
Next step after positive acetylcholine receptor antibody for MG
1) start treatment
2) ***TSH
3) CT chest to rule out thymoma
36
Features of diplopia in MG
- fatigable (generally presents at night, resolves when covering other eye)
37
Differentiating MG from Horner syndrome
Horner = impaired pupillary response (confirm)
38
Carotid dissection (ICA dissection) etiology + presentation
- following head or neck trauma or spontaneous
- acute neuro deficits + *unilateral HA (which may radiate to neck)
* transient vision loss + ipsilateral partial Horner syndrome
39
Vertebral dissection presentation + vertebral dissection vs. carotid dissection
- thunderclap HA, horner syndrome, neuro deficits, nystagmus, ataxia, dysarthria
* unlike carotid dissection, NO aphasia or weakness
40
treatment of carotid artery dissection
* just like ischemic stroke, except also anticoagulation
- lytics (if within 4.5 hours of symptom onset)
- anti platelet therapy + anticoagulation
41
First step in management of brain met
IF new-onset headache or focal neurological deficits --> IV steroids (to reduce vasogenic edema and mass effect)
42
Appearance of brain met on MRI
- ring-enhancing lesion
| - vasogenic edema
43
Met on DWMRI vs an abscess
- brain mets don't cause restricted diffusion on DWMR (whereas, an abscess dose)
44
WBRT vs surgery in general for brain mets
```
WBRT = multifocal brain mets
Solitary = surgical resection
```
45
Interventions associated with decreased rate of decline of mild cognitive impairment
- physical exercise
- cognitive activities
- active social interactions
46
Treatment of myasthenic crisis
- plasma exchange or IVIG
| * steroids also added for longer-term symptom relief
47
other features of idiopathic intracranial hypertension
- "whooshing" tinnitus (
- papilledema
- pulsatile headache
- diplopia or blurry vision
48
papilledema appearance
blurring of optic disk margins
49
initial management of idiopathic intracranial hypertension
- acetazolamide
| - weight loss
50
Presentation of vestibular schwannoma
*sensorineural hearing loss + chronic ipsilateral tinnitus + *vertigo + dysequilibrium
51
Presentation of cerebellar stroke
acute-onset vertigo + Nausea and vomiting + ataxia
52
Presentation of acute labyrinthitis
vertigo + ataxia + hearing loss
53
acute labyrinthitis vs. vestibular schwannoma
labyrinthitis = 1-2 days then then gradually improves
| vestibular schwannoma = months
54
brain abscess clinical features
- single or multiple ring-enhancing lesions at grey-white matter junction
- significant edema
* fever and leukocytosis often absent
55
Primary CNS lymphoma clinical features
single lesion + severely immunosuppressed (CD4 count less than 50)
56
PML clinical features
- CD4 count less than 200
| - multifocal areas of white matter demyelination on brain MRI with no mass effect or edema
57
Janeway lesion description from endocarditis
- erythematous macules on the palms
58
Management of pituitary incidentalomas
- Check for pituitary hyperfunction
- Visual field testing
IF no clinical features of pituitary hormonal hyper function -- measure prolactin
59
Only lab test required to thrombolytic therapy for ischemic sroke
Good glucose
60
Indication for thrombolytics in acute ischemic CVA
Within 4.5 hours of symptom onset
61
Indication for ASA in acute ischemic CVA
- within 24-48 hours of first onset
* **if timing of CVA is unknown, time of onset is when the patient was last known normal
* hold for 24h if patient receives thrombolytics
62
BP goals in acute ischemic stroke
1) Lytics given = Lower BP to 185 over 110 before giving, then maintain 180/105 for 24h
2) Lytics not given = 220 over 120
63
Management of acute ischemic stroke in patient who isn't TPA candidate
Aspirin + evaluate for mechanical thrombectomy
64
When you can discontinue lung cancer screening based on when person quit
Patient hasn't smoked for 15 years
65
PRES clinical features
- thunderclap headache
- hemiparesis
- seizures
- altered mentation
- visual impairment
66
imaging in RES
- symmetrical hyperintense T2 signal abnormalities in the subocrti al white matter of posterior parieto-occipitaq lobes
67
Cushing reflex in brain bleeds clinical features
HTN + bradycardia + Cheyne-stokes breathing
68
Presentation of bleed in the pons
- deep coma and total paralysis within minutes
| - pinpoint reactive pupils
69
Presentation of bleed in the thalamus
- upgaze palsy
- miosis
- contralateral hemiparesis and hemisensory loss
- eyes deviate Toward hemiparesis
70
Presentation of bleed in the basal ganglia
- contralateral hemiparesis and hemisensory loss
- homonymous hemianopsia
- gaze palsy
71
workup of suspected myasthenia graves in patient that is AchR-antibody negative
Test for muscle-specific tyrosine kinase receptor antibodies
72
Halos around lights can also be seen in
migraines
73
Treatment of acute dystonia
* anticholinergics (benztropine, trihexyphenidyl)
| - diphenhydramine
74
NPH clinical features
- wet, wobbly, wacky
* urinary incontinence is a late feature so may be absent initially
* can have parkinsonism like features (shuffling gait, UMN signs -- hyperreflexia, increased tone)
75
Treatment of NPH
ventriculoperitoneal shunting
76
Meniere disease clinical features
vertigo (lasting 20 minutes to several horus) + sensorineural hearing loss + tinnitus OR fullness in ear (not all have tinnitus)
77
Meniere disease management
- salt, coffee, nicotine, alcohol restriction
| - diuretics
78
cerebellar vertigo
- sudden onset, persistent vertigo
79
Meningitis treatment
- vanc + CTX
IF over 50 OR immunocompromised -- add ampicillin
*if hospital acquired (neurosurgery) or penetrating skull trauma -- need pseudomonas coverage (except for zosyn, which doesn't have CNS penetration)
80
Things to avoid post TPA
- early enteral feeding
| - no AC or anti platelet within the first 24 hours until repeat CT head shows no hemorrhagic conversion
81
Antiepileptic drug that is teratogenic
valproic acid
82
Evaluation + Management of subarachnoid hemorrhage + why
Ct head then CT-A ASAP with end-vascular approach to stabilizing the aneurysm (this will prevent rebreeding, which is the major cause of death within the first 24 hours)
- nimodipine is given to prevent recurrent vasospasm,, which doesn't typically happen until 3 days after
83
workup of foot drop
IF back pain, weakness of leg abduction --> L spine MRI (due to L5 lumbosacral radiculopathy associated with back pain)
IF weakness of foot dorsiflexion, eversion, and toe extension + no pain --> nerve conduction studies (due to common perineal nerve compression)
84
Management of post concussive syndrome following TBI
- reassurance (self-limiting, should resolve within weeks to months)
IF severely disabling or very long term -- neuropsychological testing
85
Initial steps in treatment of bacterial meningitis
IF head CT required before LP --> start empiric steroids and antibiotics before CT or LP (since CT can take up to 6 hours, you shouldn't delay treatment, even though it will reduce LP yield)
IF no head CT required --> LP prior to treatment
86
Indications for head CT before LP
- AMS
- focal neuro deficits
- immunocompromised
- new-onset seizure
- papilledema
- history of CNS disease
87
Todd's palsy clinical features
Focal weakness following a seizure
88
Glue sniffing or solvent toxicity
- AGMA that progresses to RTA with marked hypokalemia + hypophosphatemia
- above can lead to severe weakness
89
Treatment of post-herpetic neuralgia
- TCA's
| - gabapentin or pregabalin
90
CIDP clinical features
- slowly progressive weakness + sensory loss + diminished or absent reflexes
91
nystagmus features differentiating peripheral from central vertigo
```
central = greater than 1 min duration + not inhibited by fixation of gaze
peripheral = never purely vertical + inhibited by fixation of gaze + less than 1 minute duration
```
92
Management of hallucinations in lewy body dementia
- quetiapine
93
Treatment of rem sleep behavior disorder
melatonin
94
management of cognitive impairment in lewy body dementia
- cholinesterase inhibitors (donepezil, memantine)
95
core features of alzheimer
- short term memory loss
- language deficits
- spatial disorientation
96
other core feature of vascular dementia
early executive dysfunction
97
most common cause of death in ALS
respiratory failure (median survival of 5 years)
98
coronary occlusion that can cause heart block
RCA or sometimes left circle (AV node supply)
| *not LAD
99
Determining when patients need PCI for coronary lesions
- only if clinical or ECG manifestations of myocardial ischemia (not degree of stenosis alone)
