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PANCE REVIEW > Neurology > Flashcards

Neurology Flashcards

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1
Q

Amaurosis fugax

A

Monocular vision loss- temporary “lamp shade down one eye”. Seen in TIA from internal carotid artery

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2
Q

Pathophysiology of Huntington dz

A

Autosomal dominant neurodegenerative d/o of cerebral/caudate nucleus atrophy

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3
Q

Clinical symptoms of Huntington dz

A

1) dementia
2) chorea: rapid involuntary movements
3) behavioral changes

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4
Q

Pathophysiology of Parkinson’s dz

A

Idiopathic dopamine depletion with unspooled acetylcholine

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5
Q

What part of the brain does Parkinson’s effect

A

Basal ganglia

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6
Q

Clinical manifestations of Parkinson’s

A

1) tremor: resting
2) bradykinesia
3) rigidity
4) instability
5) fixes facial expression

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7
Q

Parkinson’s treatment

A

Levodopa /carvadopa (levodopa is converted to dopamine )

  • dopamine agonist
  • anticholinergics ( decrease acetylcholine)
  • MAOI ( selegiline)
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8
Q

Pathophysiology of Guillain Barre Syndrome

A

Demyelination of peripheral nerves following a URI

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9
Q

MC bacteria predisposing a patient to Guillian Barre

A

Campylobacter jejuni

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10
Q

Diagnosis of Guillain barre syndrome

A

CSF!!!!!

*high protein with normal WBC, “albuminocytological dissociation”

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11
Q

Treatment of Guillain Barre

A

1) plasmaphoresis
2) IVIG
* PREDNISONE CONTRAINDICATED

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12
Q

Pathophysiology of myasthenia Gravis

A

Autoantibodies against acetylcholine receptors, inhibiting skeletal muscle firing

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13
Q

What other d/o is highly associated with myasthenia Gravis? (75%)

A

Thymine abnormality: hyperplasia or thymoma

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14
Q

Management of myasthenia Gravis

A

Pyridostigmine: acetycholinesterase inhibitors

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15
Q

Pathophysiology of multiple sclerosis

A

Autoimmune inflammatory demyelination of the CNS

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16
Q

3 types of multiple sclerosis

A

1) relapsing remitting (MC)
2) Progressive: constant decline without exacerbations
3) secondary progressive: relapsing-remitting that becomes progressive

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17
Q

Clinical manifestations of MS

A

1) SENSORY: trigeminal neuralgia, worse with heat (uhthoff phenomonon) , Lhermitte sign (neck flexion sends pain down leg)
2) OPTIC: optic neuritis , Marcus-Gunn pupil (dilates on swinging light test)
3) UPPER MOTOR NEURON: spasticity with babinski
4) BLADDER: incontinence
5) CHARCOT’s NEURO TRIAD: 1) nystagmus 2) tremor 3) staccato speech

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18
Q

MS diagnosis

A

1) MRI with gadolinium : at least 2 white matter plaques

2) LP: IgG oligoclonal bands

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19
Q

Acute MS exacerbation to

A

1) steroids

2) plasmapheresis

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20
Q

Relapsing remitting / progressive multiple sclerosis TX

A

Beta-interferon

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21
Q

Medications that can precipitate actor angle closure glaucoma

A

sympathomimetics, anticholinergics

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22
Q

Patient complaints when experiencing actor glaucoma

A

unioccular pain, HALOS around lights, peripheral vision loss, tunnel vision

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23
Q

physical exam in acute angle closure glaucoma

A

steamy cornea, fixed-non reactive pupil

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24
Q

Management of glaucoma

A
  1. acetazolamide (decreases aqueous humor production)

2. timolol drops (decreased intra ocular pressure.

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25
Treatment of choice for absence seizures
ethosuxamide
26
treatment of status epilecticus
lorezapam (increases GABA) phenytoin (blocks Na channels) phenobarbital (binds to GABA to increase it)
27
In what nerve distribution is Bell's palsy and what disease does it have a strong association with?
Cranial nerve VII associated with HSV reactivation
28
Is there eyebrow involvement in bell's palsy?
YES, there must be complete paralysis of that side of face
29
Bell's palsy treatment
prednisone
30
Abortive drugs for migraine headaches
*the goal is to increase serotonin and decrease dopamine which will cause vasoconstriction. **do not use these drugs if any CAD or PVD present. 1) Triptans and Ergotamines (increase serotonin) 2) Metachlopromide (decrease dopamine) **give with benadryl to prevent tariff dyskinesias
31
Prophylactic drugs for migraine headaches
HTN meds such as BB, CCB, TCA, AED
32
Essential tremor: | aggravating and alleviating factors and treatment
ACTION tremor, relieved with alcohol treat with propranolol
33
Actute and prophylactic treatment of cluster headaches
actute=100% oxygen, 6-10 L | prophylactic=VERAPAMIL
34
How is the brain effected in a patient with alzheimers ?
amyloid deposition, neurofibrillary tangles (tau proteins), as well as cerebral cortex atrophy **causes a cholinergic deficiency
35
Alzheimers treatment
1) ach-esterase inhibitors; Donepezil (aricept) | 2) NMDA antagonist ; memantine
36
4 types of dementia and their ahllmarks
1) alzheimers; memory first 2) Vascular; from many lacunar infarcts 3) Frontotemporal dementia; picks dz, PERSONALITY changes 4) Lewy Body Dementia; hallucinations, delusions, parkinsonism
37
What is the MC primary CNS tumor in adults
glioblastoma multiforme aka grade IV astrocytoma
38
What is a cushion's reflex?
irregular respirations, hypertension, bradycardia in the presence of severe glioblastoma multiform
39
Glioblastoma multiforme presentation on CT or MRI
mass with hypodense center, a variable ring of enhancement surrounded by edema
40
Meningioma hallmarks
usually benign, arise from DURA -on bx you may see spindle cells, whorled pattern, or psammoma bodies (calcifications)
41
CNS lymphoma hallmarks
- epstein barr virus is a risk factor - ring enhancing lesions on imaging - methotrexate is the most effective chemo
42
Hallmarks of hemangiomas
- MC from the brainstem and cerebellum | - foam cells with high vascularity on bx
43
most common pathogen and tx for meningitis in a child
group B. strep, listeria tx with ampicillin
44
most common pathogen and tx for meningitis in 1mon-18 year old
nisseria meningitis , s. pneumo tx with ceftriaxone and vancomycin
45
most common pathogen and tx for meningitis in 18-50 y/o
S. pneumo, N. meningitis tx with ceftriaxone and vancomycin
46
most common pathogen and tx for meningitis in adult >50
S. pneumo, listeria tx with ceftriaxone and ampicillin maybe vancomycin
47
in what age ranges are you concerned about listeria meningitis
less than one month | greater than 50 years
48
What causative organism of meningitis is highly associated with the petechial rash
N. meningitis
49
LP findings consistent with bacterial meningitis
LOW glucose high protein neutrophils
50
LP findings consistent with viral meningitis
NORMAL glucose lymphocytes normal protein
51
MC cause of encephalitis
HSV, you can treat with valcyclovir
52
Treatment for restless leg syndrome?
Pramipexole, Ropinirole -These are dopamine agonists
53
What is Broca's Aphasia?
Frontal lobe nonfluency, comprehension preserved with sparse output (you can understand what is being said to you, but you can't formulate a response)
54
What is Wernicke's aphasia?
Fluent aphasia (voluminous, meaningless) with markedly impaired comprehension (you are speaking a lot of nonsense, but can't comprehend what is being said to you)
55
Treatment of a TIA
ASA and plavix
56
Workup of a TIA
- CT head - Carotid u/s - CT or MR angiography - Blood glucose - Echo
57
What are the 4 presentations of a lacunar infart?
1. Pure motor (MC) 2. Ataxic hemiparesis worse in leg than arm 3. Dysarthria clumbsy hand syndrome 4. Pure sensory loss
58
An infarct in the middle cerebral artery would present how?
- UPPER EXTREMITY involvement - Facial droop opposite lesion - gaze towards the side of the lesion
59
An infarct in the anterior cerebral artery would present how?
- LOWER EXTREMITY - face spared - personality changes, flat affect - urinary incontinence
60
An infarct in the posterior cerebral artery would present how?
Visual hallucinations, contralateral homonymous hemianopsia, drop attacks
61
What is xanthocromia?
Yellowing of the CSF due to subarachnoid hemmorhage
62
Side effects of dilantin/phenytoin
gingival hyperplasia, rash, hypotension, arrythmia
63
Order of treatment in status epilepticus
1. Benzo-lorazepmam is most effective because it has the shortest 1/2 life 2. Phenytoin-stabilizes neuronal membranes without causing CNS depression 3. Phenobarbitol-binds to GABA receptor to potentiate GABA mediated CNS inhibition

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