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Internal Medicine Mnemonics > Neurology > Flashcards

Flashcards in Neurology Deck (163):
1

Generalized Tonic-Clonic Seizures

Drugs: Valporic Acid, Phenytoin, Carbamazepine
Alt. drugs: Phenobarbital, Lamotrigine, Topiramate

2

Partial Seizures

Drugs: Carbamazepine, Lamotrigine, Phenytoin
Alt. drugs: Felbamate, Phenobarbital, Topiramate, Valporic Acid

3

Absence Seizures

Drugs: Ethosuximide, Valporic Acid
Alt Drugs: Lamotrigine, Levetiracetam, Zonisamide, Clonazepam

4

Myoclonic and Atypical Absence Syndromes

Drugs: Valporic Acid
Alt Drugs: Clonazepam, Levetiracetam, Topiramate, Zonisamide, Felbamate

5

Status Epilepticus

Lorazepam, Diazepam, Phenytoin, Phenobarbital

6

Ethanol

Most frequently abused drug, causes Wernicke-Korsakoff syndrome in overdose and delirium tremens in withdrawal

7

Thiamine

Used for prevention of Wernicke-Korsakoff syndrome

8

Diazepam

Used for treatment of alcohol withdrawal

9

Methanol

Wood alcohol, causes visual dysfunction due to formaldehyde accumulation

10

Ethylene glycol

Found in antifreeze, causes nephrotoxicity due to oxalic acid accumulation

11

Formepizole

Alcohol dehydrogenase inhibitor

12

Disulfiram

Alcohol dehydrogenase inhibitor

13

Midazolam

Used in acute anxiety attacks, anesthesia induction, preoperative sedation

14

Diazepam

Used in seizure disorders (status epilepticus), alcohol withdrawal, tranquilizer

15

Flunitrazepam

Date-rape drug

16

Flumazenil

Antidote to benzodiazepine overdose

17

Thiopental

Used in anesthesia induction, Lethal injection, Truth serum

18

Phenobarbital

Used in seizure disorders in children, can precipitate porphyria, potent inducer of CYP450

19

Parkinson's Disease (PD)

Most common form of Parkinsonism

20

Mutations of the LKKR2 gene

Most common cause of Familial PD

21

Dopamine blocking agents

Most common cause of secondary Parkinsonism

22

Protein misfolding & accumulation and mitochondrial dysfunction

Most significant pathogenic mechanism in Parkinsonism

23

Levodopa-carbidopa

Mainstay therapy for PD

24

Tremors

Major clinical effect of central-acting anticholinergic drugs

25

Amantadine

Most widely used antidyskinesia agent in patients with advanced PD and the only oral agent that has been demonstrated in controlled studies to reduce dyskinesia

26

Dementia

Most common cause of nursing home placement in PD patients

27

Essential tremor

Most common movement disorder

28

Dystonic tremor of PD

Major differentials for tremors

29

B-blockers or primidone

Standard drug therapies for essential tremors

30

Focal dystonias

Most common form of dystonia

31

Drug-induced dystonia

Most commonly seen with neuroleptic drugs or after chronic levodopa treatment in PD patients

32

SLE

Most common systemic disorder that causes chorea

33

Dystonia

Most common acute hyperkinetic drug reaction

34

Akathisia

Most common subacute drug reaction

35

Liver Biopsy

Gold standard for diagnosis of Wilson's disease

36

Tremor affecting the upper limbs

Most common psychogenic movement disorder

37

Diabetes mellitus

Most common cause of peripheral neuropathy in developed countries

38

Median neuropathy at the wrist and ulnar neuropathy at the elbow

Most common diabetic mononeuropathies

39

Seventh nerve palsy, followed by third nerve, sixth nerve, and, less frequently, fourth nerve palsies

Most common cranial mononeuropathies in DM

40

Trigeminal nerve

Most common mononeuropathies in scleroderma

41

Seventh nerve

Most common cranial nerve involved in sarcoidosis

42

Carpal tunnel syndrome

Most common mononeuropathies in uremia

43

Distal symmetric polyneuropathy

Most common form of peripheral neuropathy associated with HIV infection & usually seen in patients with AIDS

44

Lung cancer

Most common associated malignancy with neuropathies

45

GBS and myasthenia gravis

Most common causes of acute generalized weakness leading to admission in ICU

46

Guillain Barre Syndrome (GBS)

Manifests as rapidly evolving areflexic motor paralysis with or without sensory disturbance, associated with Campylobacter jejuni found in undercooked chicken

47

Myasthenia Gravis (MG)

Neuromuscular disorder characterized by weakness and fatigability of skeletal muscles, caused by a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack, associated with diplopia

48

Trainsient Ischemic Response (TIA)

Requires that all neurologic signs and symptoms resolve within 24 hrs (most last <1hr) regardless of whether there is an imaging evidence of new permanent brain injury

49

Stroke

Occurred in the neurologic signs last for more than 24 hours

50

Ischemic Penumbra

Tissue surrounding the core region of infarction is ischemic but reversibly dysfuncitonal

51

Lacunar Infarction

Refers to infarction following atherothrombotic of lipohyalinotic occlusion of a small artery (30-300 um)

52

4-10 minutes

Decrease in cerebral blood flow to zero causes death of brain tissue within

53

Nonrheumatic atrial fibrilation

Most common cause of cerebral embolism overall

54

Carotid bifurcation atherosclerosis

Most common source of artery to artery embolism

55

Common carotid bifurcation and proximal internal carotid artery

Atherosclerosis within the carotid artery occurs most frequently in

56

Transient symptoms (small vessel TIA)

Herald a small-vessel infarct

57

Hypertension

Most significant risk factor of stroke and TIA

58

Aspirin

Only antiplatelet agent that has proven effective for the acute treatment of ischemic stroke

59

Headache

Principal side effect of dipyridamole

60

Within 2 weeks of symptom onset (benefit is more pronounced in men>75 y.o.)

Endarterectomy for carotid atherosclerosis is most beneficial when performed

61

Hallmark of top of the basilar artery occlusion

Sudden onset of bilateral signs, including ptosis, papillary asymmetry or lack of reaction to light and somnolence

62

Plain cranial CT

Imaging modality of choice in patients with acute stroke to rule out bleed

63

Conventional x-ray cerebral angiography

Gold standard for identifying and quantifying atherosclerotic stenoses of arteries

64

Trauma

Bleeding into subdural and epidural spaces is principally produced by

65

Basal ganglia (especially putamen), thalamus, cerebellum, pons

Most common sites of hypertensive intraparenchymal hemorrhage

66

Putamen (Sentinel) sign: contralateral hemiparesis

Most common site of hypertensive hemorrhage

67

Cerebral amyloid angiopathy

Most common cause of lobar hemorrhage in the elderly

68

Choriocarcinoma Malignant melanoma Renal cell carcinoma Bronchogenic carcinoma

Most common metastatic tumors associated with intracerebral hemorrhage

69

>3cm in diameter

Most cerebellar hematomas of this diameter will require surgical evacuation

70

Seizure

Paroxysomal event due to abnormal excessive or synchronous neuronal activity in the brain

71

Epilepsy

Condition where a person has recurrent seizures due to underlying causes not associated with structural brain damage

72

Triad of Lennox-Gastaus Syndrome

1. Multiple seizure typers (usually generalized tonig-clonic, atonig, and atypical absence seizures)

73

Early childhood and late adulthood

Highest incident of seizures

74

Daydreamind and a decline in school performance recognized by the teacher

First clue of typical absence seizures

75

Electrophysiologic hallmark of typical absence seizures

Generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends abruptly, superimposed on a normal EEG background

76

Generalize tonic-clonic seizures

Main seizure type in 10% of all persons with epilepsy

77

Generalize tonic-clonic seizures

Most common seizure type resulting from metabolic derangements

78

Metabolic disorders

Degenerative CNS diseases

79

Anoxic brain injury

Pathologic myoclonus is the most commonly seen in association with

80

Mesial Temporal Lobe Epilepsy Syndrome

Most common syndrome associated with focal seizures with dyscognitive features

81

Febrile seizures

Most common seizures arising in late infancy and early childhood

82

First goal in the approach to seizure

Determine if event was truly a seizure

83

Valporic acid Lamotrigine

Best initial choice for the treatment of primary generalized tonig-clonic seizures

84

Valpotic acid

Drug choice in patients with generalized epilepsy syndromes having mixed seizure types

85

Key determinants in initiation and the monitoring of therapy

Clinical measures of seizure frequency and presence of side effects, not the laboratory values

86

First 3 months after discontinuing therapy

Most recurrences of seizure occur in the

87

Most common surgical procedure for patients with temporal lobe epilepsy

Resection of the anteromedial temporam lobe (temporal lobectomy) or a more limited removal of the underlying hippocampus and amygdala (amygdalohippocampectomy)

88

First task in the approach to CNS infection

Identify whether an infection predominantly involves the subarachnoid space (meningitis) or whether there is evidence of either generalized or focal involvement of brain tissue in the cerebral hemispheres, cerebellum, or brainstem

89

Bain tissue is directly injured by a viral infection

Encephalitis

90

Fever, headache, and nuchal rigidity

Classical clinical triad of meningitis

91

Headache, fever, focal neurologic deficit (present in <50%)

Classic clinical triad of brain abscess

92

Cerebritis

Non-encapsulated brain abscess

93

Nuchal rigidity ("stiff neck")

Pathognomonic sign of meningeal irritation and is present when neck resists passive flexion

94

Bacterial meningitis

Most common form of suppurative CNS infection

95

S. pneumoniae

Most common cause of meningitis in adults>20 years

96

Petechial or purpuric skin lesions

Important clue to diagnosis of meningococcal infection

97

Cerebral herniation

Most disastrous complication of increased ICP

98

S. pneumoniae and N. meningitides

Most common etiologic organisms of community-acquired bacterial meningitis

99

Enteroviruses, HSV type 2, HIV, Arboviruses

Most important agents in acute viral meningitis

100

Headache

Most common symptom of brain abscess

101

Combination of high dose parenteral antibiotics and neurosurgical drainage

Optimal therapy for brain abscess

102

Cranial MRI

Preferred diagnostic test for any patient suspected of having a brain tumor, and should be performed with gadolinium contrast administration

103

Neuroimaging

The only test necessary to diagnose a brain tumor

104

Dexamethasone

Glucocorticoid of choice for brain tumors because of its relatively low mineralocorticaoid activity

105

The only established risk factors for primary brain tumors

Exposure to ionizing radiation: meningiomas, gliomas, schwannomas Immunosuppression: primary CNS lymphoma

106

Most common primary brain tumor of childhood

Grade I astocytomas: pilocytic astrocytomas (WHO grade I)

107

Meningiomas

Most common primary brain tumor overall

108

Epstein-Barr Virus (EBV)

Frequently plays an important role in the pathogenesis of HIV-related primary CNS lymphoma

109

Medulloblastomas

Most common malignant brain tumor of chilhood

110

Grade IV astrocytoma (Glioblastoma)

Most common malignant brain tumor overall

111

Cerebral convexities

Where meningiomas are most commonly located

112

Dural metastasis

Main differential diagnosis for meningioma

113

Most common schwannomas

Vestibular schwannomas or acoustic neurons

114

Gray matter-white matter junction

Most common site of brain metastases

115

Supratentorial

85% of all brain metastases are

116

Lung and breast cancer

Most common sources of brain metastases

117

Melanoma

Malignancy with greatest propensity for brain metastasis, found in 80% of patients at autopsy

118

Prostate and breast cancer

Malignancies with propensity to metastasize to the dura and can mimic meningioma

119

MRI

Brain metastases are best visualized on ___ where they appear as well-circumscribed lesions

120

Melanoma, thyroid, kidney cancer

Cancers with greatest propensity to bleed

121

Lung cancer

Most common cause of hemorrhagic metastasis

122

Acute leukemia

Most common among hematologic malignancies to matastasize to the subarachnoid space

123

Breast and lung carcinomas and melanoma

Solid tumors that most frequently cause leptomeningeal metastases

124

Demonstration of tumor cells in CSF

Definitive method and often considered the gold standard to diagnose leptomeningeal metastases

125

Hematologic malignancies

CSF cytologic examination is most useful in

126

Thoracic spine, followed by the lumbar and then cervical spine

Part of the spine affected most commonly in epidural metastasis

127

Back pain

Presenting symptom of epidural metastasis in virtually all patients

128

MRI of the complete spine

Best test for epidural metastasis

129

Complete removal of the mass, typically anterior to the spinal canal

Surgical procedure of choice for epidural metastasis

130

Whole-Brain Radiotherapy (WBRT)

Standard treatment for beain metastases

131

Late delayed toxicity

Most serious toxicity from radiotherapy as they are often irreversible

132

Leukoencephalopathy

Complication seen most commonly after WBRT

133

Neurotoxicity

Second only to myelosupression as dose-limiting toxicity of chemotherapeutic agents

134

Vomiting that precedes headaches

Highly characteristic of posterior fossa brain tumors

135

Headache

Dominant symptom in temporal (giant cell) arteritis

136

Migraine, tension-type headache, and cluter headache

Most common primary headache syndromes

137

Trigeminovascular input from the meningeal vessels

Key pathway for pain in migraine

138

Migraine

Most disabling headache

139

Judicious use of one or more drugs that are effective in migraine

Mainstays of pharmacologic therapy in migraine

140

Severity of the attack

Most important factor in selection of the optimal regimen for a migraine patient

141

Most effective drug classes in the treatment of migraine

Anti-inflammatory agents, 5-HT, 1B/1D receptor agonists (triptans), and dopamine receptor antagonists

142

Most efficacious of the triptans

Rizatriptan and eletriptan

143

Periodicity

Core feature of cluster headache

144

Most satisfactory treatment in cluster headache

Administration of drugs to prevent cluster attacks until the bout is over

145

Subarachnoid hemorrhage

Most serious cause of secondary headache

146

Most evident in the morning and improves during the day

Classic headache associated with a brain tumor

147

Sympathetic Effects

Myrdiasis, sweating, increased heart rate, bronchodilation, GU and GI contraction, uterine relaxation and contraction, vasodilation of the skeletal muscles, vasoconstriction of the skin and GI tract, ejaculation

148

Adrenergic receptors

Alpha-1 (for smooth muscle contraction in sphincters, radial muscle of the iris, vasoconstriction)

149

CN III (Oculomotor nerve)

Cranial nerve for opening of eyelids, contraction of most EOMs, accommodation and pupillary constriction

150

CN VII (Facial nerve)

Cranial nerve for specail sensation (taste) of the anterior 2/3 of the tongue

151

CN V (Trigeminal nerve)

Cranial nerve for general sensation (e.g. pain) of the anterior 2/3 of tongue

152

CN VII (Facial nerve)

Cranial nerve for facial muscles

153

CN V (Trigeminal nerve)

Cranial nerve for facial sensation and muscles of mastication

154

Acetylcholine (Ach)

Found in various sites (e.g. ANS and NMJ), decreased in HUntington's dementia and Alzheimer's dementia

155

Norephinephrine (NE)

Found in the locus ceruleus of the pons, for arousal/wakefulness

156

Dopamine

Found in the substantia nigra, decreased in Parkinson's disease, increased in schizophrenia, for fine-tuning of movements

157

Serotonin

Found in the median raphe of the brainstem, derived from tryptophan, converted to melatonin, involved in mood and sleep

158

Glycine

Found in spiral interneurons, main inhibitory neurotransmitter

159

GABA

Found in the brain, main inhibitory neurotransmitter, from glutamate

160

Glutamate

Excitatory neurotransmitter in the CNS

161

Hippocampus

Output pathway from reward and punishment centers, lesions here will produce anterograde amnesia

162

Thalamus

Helps seach memory storehouses, lesions here will produce retrograde amnesia

163

Beta waves, Alpha waves, Delta waves

Waves in the EEG of alert, sleeping, and relaxed individuals, respectively