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American Board of Internal Medicine COPY > Neurology > Flashcards

Neurology Flashcards

1
Q

If the Anterior Cerebral Artery is ischemic, what clinical feature manifests?

A

Contralateral leg weakness

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2
Q

If the Middle Cerebral Artery is ischemic, what clinical feature manifests?

A
  1. Contralateral face and arm weakness&raquo_space; leg
  2. Sensory loss
  3. Visual field cut
  4. Aphasia or neglect
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3
Q

If the Posterior Cerebral Artery is ischemic, what clinical feature manifests?

A

Contralateral visual field cut

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4
Q

If the Lacunar brain is ischemic, what clinical feature manifests?

A
  1. Contralateral motor/sensory without cortical signs:
    • aphasia
    • apraxia
    • neglect
    • loss of higher cognitive functions
  2. Clumsy hand-dysarthria syndrome
  3. Ataxic hemiparesis
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5
Q

If the Basal Artery is ischemic, what clinical feature manifests?

A
  1. Oculomotor deficits
  2. Ataxia with “crossed” sensory/motor deficits
    • crossed = sensory and motor opposite sides
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6
Q

If the Vertebral Artery is ischemic, what clinical feature manifests?

A
  1. Lower cranial nerve deficits:
    • dysphagia
    • dysarthria
    • tongue/palate deviation
  2. Ataxia with “crossed” sensory/motor deficits
    • crossed = sensory and motor opposite sides
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7
Q
  1. How is Myasthenia Gravis diagnosed (5)?
  2. What is the treatment for Myasthenic Gravis?
  3. What is the treatment for Myasthenic Crisis?
A
  1. a. Acetylcholine antibodies
    b. If negative, Anti-MuSK (muscle-specific kinase antibodies)
    c. TSH (associated with MG)
    d. EMG
    e. CT scan to exclude thymoma
  2. Pyridostigmine
  3. Plasma exchange
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8
Q

What drugs should be avoided in patients with a history of Myasthenia Gravis (5)?

A
  1. Fluoroquinolones
  2. Aminoglycosides (gent, tobra)
  3. Macrolides
  4. Magnesium
  5. Lithium
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9
Q

What are contraindications to tPA (11)?

A
  1. Rapidly improving symptoms
  2. Intracerebral hemorrhage
  3. Seizure with stroke
  4. CVA or head trauma in 3 months
  5. Major surgery or trauma in 2 weeks
  6. BP > 185/110
  7. Heparin in 48 hours
  8. INR >1.7
  9. Plt 400
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10
Q

What is the size threshold for treatment of a cerebral aneurysm?

A

> 7 mm

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11
Q

When should Nimodipine be given in the setting of a CNS event, and why?

A

After SAH to reduce risk of secondary ischemia

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12
Q

What is treatment for a prochlorperazine-induced dystonic reaction?

A
  1. Anticholinergics: Benztropine/Diphenhydramine

2. Benzodiazepines

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13
Q
  1. What is used in Mild Cognitive Impairment?
  2. What is used in Mild-Moderate Alzheimers (3)?
  3. What is used in Moderate-Severe Alzheimers?
A
  1. COGNITIVE REHAB!!
  2. Acetylcholinesterase Inhibitors:
    a. Donepezil
    b. Rivastigmine
    c. Galantamine
  3. Memantine
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14
Q

What are treatments for Relapsing-Remitting Multiple Sclerosis (5)? Which of these have caveats?

A
  1. HIGH-DOSE Methylprednisolone
  2. Interferon-beta (unless liver dz or depression)
  3. Glatiramer
  4. Natalizumab - risk progressive multifocal leukoencephalopathy
  5. Mitoxantrone - risk cardiotoxicity
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15
Q
  1. What features are not consistent with ALS (3)?

2. What is treatment for ALS?

A
  1. a. Sensory or pain symptoms
    b. Cognitive impairment
    c. Ocular muscle weakness
  2. Riluzole - additional three months
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16
Q
  1. Which Parkinson medications are used in younger patients less than 65?
  2. In older patients more than 65?
A
  1. Dopamine agonists:
    a. Pramipexole
    b. Ropinirole
  2. Levodopa-carbidopa
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17
Q

What are the key features to Migraines (5)?

A 
POUND
    Pulsatile quality
    One-day duration (4-72 hours)
    Unilateral location
    Nausea or vomiting
    Disabling intensity
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18
Q
  1. What is treatment for Tension Headaches?

2. What is prophylaxis for Tension Headaches?

A
  1. NSAIDs

2. (previously) Tricyclic Antidepressants

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19
Q
  1. What is treatment for Cluster Headaches?

2. What is prophylaxis for Cluster Headaches?

A
  1. Triptans or corticosteroids and oxygen

2. Verapamil

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20
Q
  1. What is treatment for Trigeminal Neuralgia?

2. What is prophylaxis for Trigeminal Neuralgia?

A
  1. Carbamazepine

2. None

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21
Q
  1. What is treatment for Migraines (3 scenarios)?
  2. WHEN is prophylaxis for migraines indicated?
  3. What is prophylaxis for Migraines (7)?
A
  1. a. First: APAP or NSAIDs or Aspirin
    b. Second: Triptan
    c. Rescue: Codeine, Hydrocodone, Oxycodone
  2. Episodes 8-10 per months
  3. a. Topiramate - esp epilepsy
    b. Valproic Acid - esp epilepsy
    c. Amitriptyline - esp depression
    d. Metoprolol - esp HTN
    e. Propranolol
    f. Timolol
    g. Butterbur extract
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22
Q

When are triptans contraindicated (2)?

A
  1. OCP

2. Coronary Artery Disease

23
Q

What is treatment for:

  1. Partial (simple/complex) Seizures
  2. Generalized Seizures
A
  1. a. Carbamazepine
    b. Phenytoin
    c. Lamotrigine (esp. older)
  2. a. Valproic Acid
    b. Lamotrigine
24
Q
  1. Which seizure medication is “safest” in pregnancy?

2. Which seizure medications should be discontinued in pregnancy (3, highest to lowest risk)?

A
  1. Carbamazepine
  2. a. Valproic Acid (category D)
    b. Phenytoin
    c. Phenobarbital
25
Q
  1. What is Tarsal Tunnel Syndrome?

2. How is it treated?

A
  1. Tingling along medial foot to great toe
  2. a. Local corticosteroid injection
    b. Decompression surgery
26
Q
  1. What is Bell Palsy?

2. How is it treated?

A
  1. Upper and lower face weakness

2. Prednisone within 72 hours

27
Q

What is the differential for Mononuritis Multiplex (8)?

A
  1. Vasculitis (painful)
  2. Lymphoma
  3. Amyloidosis
  4. Sarcoidosis
  5. Lyme disease
  6. HIV
  7. Leprosy
  8. Diabetes
28
Q

What is treatment for Guillain-Barre?

A
  1. Plasma exchange

2. IVIG

29
Q
  1. What is first-line treatment for parenchymal or leptomeningeal tumors?
  2. What follows for parenchymal metaseses from known primary tumors?
  3. What follows for leptomeningeal metaseses from leukemia and lymphoma?
A
  1. Corticosteroids
  2. Whole brain radiation
  3. Chemotherapy with MTX and Cytarabine
30
Q
  1. What is another name for Idiopathic Intracranial Hypertension and what are its clinical features (4)?
  2. What features are found on exam?
  3. What is treatment?
A
  1. Pseudotumor Cerebri
    a. Headache
    b. Pulsatile tinnitus
    c. Transient visual obscurations
    d. Occurs in obese women
  2. Sixth cranial nerve palsy - impaired lateral gaze due to abducens nerve palsy
  3. Acetazolamide
31
Q
  1. What medication is used for premenstrual-related migraine?
  2. What migraine medications are safest during PREGNANCY, as first-line (3)?
  3. What migraine medication is safest during breast-feeding (2)?
A
  1. Mefenamic Acid 2 days prior
  2. APAP + Metoclopramide/Ondansetron
  3. Frovatriptan or Sumitriptan
32
Q

What are features of Multiple System Atrophy (3)?

A
  1. Autonomic - orthostasis
  2. Cerebellar - ataxia
  3. Extrapyramidal - Parkinson
33
Q

Which seizure medications are preferred in patients with liver disease (3)?

A
  1. Levetiracetam
  2. Gabapentin
  3. Pregabalin
34
Q

Describe the MMSE scores for the different levels of Alzheimer Dementia (3). Which have recommended regimens?

A

24-30 = Mild Cognitive Impairment
- Cognitive Rehabiliation

19-24 = Mild ALZHEIMER
- Ach-inh Donepezil, Rivastigmine, Galantamine

10-19 = Moderate ALZHEIMER
- NMDA-blocker Memantine

<10 = Severe

35
Q

What are features of Normal Pressure Hydrocephalus (3)?

A
  1. Wet - Urinary incontinence
  2. Wobbly - gait apraxia
  3. Weird - dementia
36
Q
  1. What is the pathophysiology of Wernicke’s encephalopathy?

2. What are its features (4)?

A
  1. Thiamine (B1) deficiency
  2. a. Mental status changes
    b. Ophthalmoplegia
    c. Nystagmus
    d. Ataxia - unsteady gait
37
Q
  1. What serologic test is useful in the diagnosis of Lambert-Eaton myasthenic syndrome?
  2. What nonserologic test can be performed?
A
  1. Voltage-gated P/Q-type calcium channel antibodies

2. Pre- and post-conduction studies - positive if increase in muscle potential amplitude

38
Q
  1. Following ischemic stroke treated with tPA, what should the target blood pressures be and for what period of time?
  2. What are appropriate treatment options (2)?
A
  1. Less than 180/105 for 24 hours after rtPA treatment

2. IV labetalol or nicardipine

39
Q

What medication is used in the setting of a carotid dissection, and why?

A

Heparin to prevent distal thromboembolism

40
Q

What are features of Progressive Supranuclear Palsy, including those that distinguish it from Parkinsons (6)?

A
  1. Gait impairment
  2. Falls **early
  3. Bulbar signs: Dysphagia/Dysarthria
  4. OPHTHALMOPLEGIA - vertical then horizontal gaze
  5. LACK of tremor
  6. LACK of levodopa responsiveness
41
Q

What are characteristic changes to personality following dopaminergic agonists(3), and what is the physiology?

A
  1. New onset Gambling
  2. Excessive shopping
  3. Hypersexuality

Drugs like Ropinirole or Pramipexole affect dopaminergic reward centers in the brain

42
Q

What scoring measurement is used to determine stroke risk after TIA?

A 
ABCD2 score
    - Age greater than 60
    - Blood pressure greater 140/90
    - Clinical
           2 points unilateral weakness
           1 points speech impairment without weakness
    - Diabetes
    - Duration
           2 points greater than 60 mins
           1 points greater than 10-59 mins

Low risk less than 4 (1.2 - 3.1%)
Moderate risk 4-5 (5.9 - 9.8%)
High risk greater than 5 (11.7 - 17.8%)

43
Q

What are the levels of neurologic lesions (7) and how are they differentiated?

A
  1. Brain
  2. Brainstem (CN, cerebellar)
  3. Spinal Cord (bowel, bladder, ED)
  4. Motor Neuron (only MOTOR, fasciculation)
  5. Peripheral Nerve (sensory > motor, distal)
  6. Neuromuscular Junction (only MOTOR)
  7. Muscle (only MOTOR)
44
Q
  1. What EEG finding suggest seizure disorder (2)?

2. What imaging modality is superior in the setting of seizures?

A
  1. a. Sharp waves
    b. Spikes
  2. MRI with T1-weighted and T2-weighted
45
Q
  1. Which seizure medication treats Absence?

2. Which drug exacerbates Absence or Myoclonic?

A
  1. Ethosuximide

2. Carbamazepine

46
Q

What are the three Trigeminal Autonomic Cephalagias? Compare duration, frequency, acute treatment and prevention.

A

Trigeminal Autonomic Cephalagias - unilateral headache associated with cranial autonomic features (lacrimation, nasal congestion, rhinorrhea, conjunctival injection)

Cluster headache

- Duration 1 hour
- Frequency 1-3 per day
- Acute: Oxygen, Triptans
- Prevent: Verapamil, steriods, etc..

Paroxysmal hemicrania

- Duration 15 mins
- Frequency 11 per day
- Acute: None
- Prevent: Indomethacin

SUNCT (Short-Lasting Unilateral Neuralgiform with Conjunctival injection and Tearing)

- Duration 60 seconds
- Frequency 30-200 per day
- Acute: None
- Prevent: Lamotrigine
47
Q

What are the grades of concussions, and how are they treated differently?

A

I: No LOC but momentary confusion

II: No LOC but 15 minutes of AMS

- requires medical observation
- no return that day
- imaging if persistent neuro changes

III: LOC
- minimum one week off sports

48
Q
  1. In the setting of an ischemic stroke not amenable to tPA, what is the blood pressure goal? How about HEMORRHAGIC stokes?
  2. What are exceptions (6)?
A
  1. a. Ischemic = 220/120
    b. Hemorrhagic = 160/90 (if s/s ICH 140)
  2. Evidence of end-organ damage:
    a. Preeclampsia
    b. HTN encephalopathy
    c. Aortic dissection
    d. Cardiac ischemia
    e. CHF
    f. Acute Kidney Injury
49
Q

What test will distinguish Myasthenia Gravis from Lambert-Eaton?

A

Edrophonium - AchE inhibitor (reversible)

  • Improve muscle strength with MG
  • Does not improve with Lambert-Eaton
50
Q

Following hemorrhagic stroke, in how many days can your resume VTE prophylaxis with heparin?

A

4 days

51
Q

What is a treatment for MS-fatigue (2)?

A
  1. Amantadine - anti-viral and anti-Parkinson

2. Modafinil

52
Q

What migraine prophylaxis medication is contraindicated with nephrolithiasis (2)?

A
  1. Topiramate
  2. Zonisamide

**Can cause calcium crystal formation

53
Q

When is nitroprusside contraindication?

A

After ischemic stroke or hemorrhage because it can lead to INCREASED INTRACRANIAL PRESSURE

American Board of Internal Medicine COPY (15 decks)

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