Neurology Flashcards
(159 cards)
1
Q
What type of genetic disorder is Huntington disease?
A
Autosomal dominant
2
Q
What is the patho of Huntington disease?
A
trinucleotide repeats (CAG/glutamine) of the Huntington gene (chromo 4)
3
Q
What age does Huntington disease usually appear?
A
30-50yr
4
Q
What are the 3 classic signs of Huntington disease?
A
progressive chorea, rigidity, and dementia, frequently associated with seizures.
5
Q
How is Huntington dx diagnosed?
A
sx + family hx+ genetic confirmation
6
Q
What is seen on imaging for Huntington dx?
A
cerebral & striatal (caudate nucleus & putamen) atrophy
7
Q
Txt for Huntington dx?
A
None, fatal in 15-20yr, genetic counseling
8
Q
1st FDA approved txt for chorea associated with Huntington dx?
A
Tetrabenazine
9
Q
MC cause of primary headaches?
A
tension headaches
10
Q
Bilateral, pressing, tightening “band like” non-throbbing headache?
A
tension headache
11
Q
What is seen on PE for tension headaches?
A
pericranial muscle tenderness to the head, neck, or shoulders
12
Q
Tx for tension headache?
A
NSAIDS
13
Q
Dx of tension headaches?
A
clinical
14
Q
severe, unilateral periorbital or temporal pain headache?
A
cluster headache
15
Q
What can trigger a cluster headache?
A
alcohol, stress, specific foods
16
Q
When are cluster headaches worse?
A
at night
17
Q
Horner’s syndrome?
A
ptosis, miosis, anhidrosis
18
Q
What is seen on PE for cluster headaches?
A
horner’s syndrome, nasal congestion, rhinorrhea, conjunctivitis, lacrimation
19
Q
1st line txt for cluster headache?
A
100% oxygen followed by anti-migraine meds
20
Q
1st line prophylaxis for cluster headaches?
A
Verapamil
21
Q
What is the MC type of migraine?
A
migraine without aura
22
Q
What type of focal neurologic symptoms is the most common type during a migraine?
A
visual
23
Q
When should a CT be used to dx migraine?
A
- onset of migraine > 50y
- first or worse severe headache
- new daily, persistent headache
24
Q
1st line txt for migraine?
A
NSAIDS, Acetaminophen, Aspirin
25
What can be added to improve meds during migraines?
caffeine
26
2nd line txt for migraines?
Triptans or Ergotamines
27
Prophylactic txt for migraines?
anti-hypertensives = BB and CCB
28
C/I to triptans?
ischemic stroke, heart dx, uncontrolled hypertension, pregnancy
29
Adv event of triptans?
chest tightness from vasoconstriction
30
Adv event of ergotamines?
rebound headache
31
Used for abortive migraine therapy?
IV Metoclopramide
32
What nerve does bell palsy affect?
VII
33
What is bell palsy closely related too?
Herpes simplex virus reactivation
34
What sx are seen in bell palsy?
Ear pain, unilateral facial weakness, taste disturbance, inability to completely close eyelid
35
Txt for Bell palsy?
Supportive- eye drops
Prednisone
Acyclovir
36
What txt for bell palsy should be given within the first 72hrs to decrease recovery time?
Prednisone
37
When used in combination can in severe cases can improve symptoms and timing of recovery of bell palsy?
Acyclovir and glucocorticoids
38
In bell palsy weakness and paralysis only affects?
The face
39
What is the MC cause of Gillian barre?
Campylobacter jejuni
40
What is gullain barre syndrome?
Demyelination polyradiculopathy of the peripheral nervous system
41
Sx of guillain barre?
Symmetric ascending weakness and sensory changes
42
What is a life threatening symptom of guillain barre?
Weakness of respiratory muscles
43
Sx of guillan barre?
Nerve conduction studies
| CSF analysis
44
What is seen on CSF for Guillain barre?
High protein
Normal WBC
Normal glucose
45
Txt for Guillain Barre?
Plasmapheresis or IVIG
46
What txt should not be used for Guillan Barre?
Prednisone
47
What is the prognosis for Guillan Barre?
60% full recovery in 1yr
48
What is MS?
autoimmune, inflammatory demyelinating disease of the CNS
49
What axon degeneration does MS affect?
white matter (brain & spinal cord)
50
What type of MS is the MC?
relapsing-remitting
51
What is the MC presenting symptoms of MS?
weakness and visual disturbances
52
What visual disturbances are seen in MS?
diplopia, optic neuritic
53
What is Uhthoff's phenomenon?
worsening of symptoms w/ heat
54
What is Lhermitte's sign?
neck flexion causes lightning shock type pain radiating from the spine down the leg
55
The best initial and accurate test for MS?
MRI w/ gadolinium (contrast)
56
What proof is needed to dx MS?
2 areas of white matter involvement
57
If MRI is inconclusive what other test can be used to dx MS?
Lumbar puncture
58
What is seen on lumbar puncture for MS?
increased IgG & oligoclonal bands
59
1st line txt for MS?
IV glucocorticoids
60
Prevention of MS?
Beta-interferon or Glatiramer
61
What vitamin deficiency puts you at risk for MS?
Vitamin D
62
Patho of Myasthenia gravis?
autoantibodies against acetylcholine postsynaptic receptor at the neuromuscular junction
63
2 main symptoms of Myasthenia gravis?
ocular weakness
| generalized weakness
64
Weakness is worsened with repeated muscle use and throughout the day with activties?
Myasthenia gravis
65
What is myasthenia crisis?
respiratory muscle weakness
66
What is the outpatient dx of myasthenia gravis?
acetylcholine receptor antibodies
67
What is the most accurate outpatient test for myasthenia gravis?
electrophysiology testing
68
What is the dx for emergent myasthenia gravis?
Edrophonium (Tensilon) test- brief improvement of sx
| Ice pack test
69
What is the long term txt for myasthenia gravis?
Acetylcholinesterase inhibitors: Pyridostigmine or Neostigmine
70
What is the txt for myasthenia crisis?
Plasmapheresis or IVIG
71
Possible curative txt of myasthenia gravis?
thymectomy
72
What is parkinson disease?
idiopathic loss of dopaminergic neurons in the substantia nigra.
73
Triad of symptoms seen in Parkinson disease?
resting tremor, bradykinesia, muscle rigidity
74
What is the 1st symptom of Parkinson dx?
resting tremor
75
Dx of Parkinson?
autopsy, lewy bodies and loss of pigment cells in the substantia nigra
76
Most effective txt for Parkinson?
Levodopa- carbidopa
77
1st line txt for pts < 65yr with Parkinson?
dopamine agonists- Bromocriptine
78
What is the role of Carbidopa?
reduces the amount of Levodopa needed, keeps it from being being metabolized in the gut, liver and other tissue
79
What should be used in monotherapy for patients with Parkinson with tremor as a predominant symptom?
anticholinergics- Trihexylphenidly, Benztropine
80
What virus is associated with encephalitis?
Herpes simplex virus-1
81
What symptoms are seen in encephalitis?
headache, neck stiffness, photosensitivity, fever, seizures, altered mental status
82
What symptoms distinguishes encephalitis from aseptic meningitis?
altered mental status
83
Dx of encephalitis?
CT first, then lumbar puncture
84
What is seen on lumbar puncture for encephalitis?
increased lymphocytes, normal glucose
85
What part of the brain is usually affected in encephalitis?
temporal
86
The most accurate test for herpes encephalitis?
PCR
87
Txt for HSV encephalitis?
IV acyclovir
88
DOC of concussion?
CT head without contrast
89
DOC for prolonged symptoms of a concussion?
MRI
90
Txt for concussion?
cognitive and physical rest
91
How long should pts be watched after a concussion?
min of 24hrs
92
When can a person resume strenuous activities after a concussion?
upon resolution of symptoms and recovery of memory as well as cognitive functions
93
When can a athletic return to play after a concussion?
We recommend that athletes NOT return to play the same day after concussion, and also that athletes NOT return to play until asymptomatic off medication
94
What type of genetic disorder is essential tremor?
autosomal dominant
95
What type of tremor is seen in essential tremor?
postural bilateral action tremor
96
What part of the body does essential tremor affect?
upper extremities and head
97
Tremor that is worsened with intentional movement and emotional stress?
essential tremor
98
What tremor is improved w/ alcohol?
essentital tremor
99
Dx of essential tremor?
exclusion, family hx
100
Txt for essential tremor?
only txt if it interferes
101
Txt for severe or situational essential tremor?
Propranolol
102
2nd txt for essential tremor?
Primidone
103
Initial dx of transient ischemic attack?
CT scan
104
Definitive dx of transient ischemic attack?
conventional angiography
105
Txt for non-cardiogenic TIA?
Antiplatelet therapy- aspirin, clopidogrel
106
Txt for internal carotid artery stenosis 50-99%?
carotid endarterectomy
107
Txt for cardiogenic artery stenosis?
oral anticoagulation
108
What is a focal partial seizure?
one discrete part of the brain
simple- w consciousness
complex- w/o consciousness
109
MC childhood seizure?
Absence Petit mal
110
What is seen on EEG for absence seizures?
bilateral symmetric 3 Hertz spike and wave activity
111
Txt for absence seizures?
Ethosuximide
112
Second line txt for absence seizures?
Valproic acid
113
Txt for generalized grand mal seizures?
Levetiracetam
114
Txt for status epliepticus?
Benzo (Lorazepam)
115
Second line tx for status epliepticus?
Phenytoin or Fosphenytoin
116
Third line txt for status epliepticus?
Phenobarbital
117
Definitive txt for status epilepticus if no meds work?
general anesthesia
118
Giant cell arteritis has a similar clinical spectrum too?
polymyalgia rheumatica
119
Sx of giant cell arteritis?
headache, jaw claudication, visual changes, scalp tenderness
120
Definitive dx for giant cell arteritis?
temporal biospy
121
Txt for giant cell arteritis?
high dose corticosteroids
122
MC complication of giant cell arteritis?
blindness
123
What is use to monitor txt effectivity in giant cell arteritis?
sedimentation rate
124
Sx of deliruim?
fluctuating mental status changes and marked deficit in short term memory
125
Three patho of alzheimer dx?
beta-amyloid plaques
neurofibrillary tangles
acetylcholine deficiency
126
What is the 1st sx in dementia?
short term memory loss
127
Dx of dementia?
r/o, MRI
128
Txt of dementia?
acetylcholinesterase inhibitors-Donepezil, Tacrine, Rivastigmine, Galantamine
129
Best add on drug for dementia?
Memantine
130
MC and most aggressive primary malignant CNS tumors in adults?
Glioblastoma multiforme
131
DOC for brain tumors?
MRI w/ contrast
132
Txt for brain tumors?
excision, radiation
133
Most benign brain tumor?
astrocytoma
134
MC cause of meningitis in adults?
strep pneumoniae
135
MC cause of meningitis in older children (10-19y)?
neisseria menigitidis
136
MC cause of meningitis in newborns?
group B strep
137
MC cause of meningitis in the immunocompromised?
Listeria monocytogenes
138
What is Brudzinski sign?
neck flexion produces knee or hip flexion
139
What is Kernig sign?
Inability to extend the knee/leg with hip flexion
140
Dx of meningitis?
lumbar puncture
141
What is seen on lumbar puncture in meningitits?
decrease glucose, increase neutrophils, increase protein, increase opening pressure
142
Txt for bacterial meningitis?
Vancomycin + Ceftriaxone
143
Txt for listeria meningitis?
Vancomycin + Ceftriaxone + Ampicillin
144
What should be given w/ abx in bacterial meningitis?
Dexamethasone
145
Post-exposure prophylaxis for bacterial meningitis?
Ciprofloxacin or Rifampin
146
What is complex regional pain syndrome?
autonomic dysfunction following bone or soft tissue injuries
147
Sx of complex regional pain syndrome?
pain, hypalgesia, allodynia, trophic changes,
148
Txt for complex regional pain syndrome?
NSAIDS, anesthetic blocks
149
What prophylaxis can be used after fractures to reduce complex regional pain syndrome?
Vitamin C
150
MC area of berry aneruysm?
Circle of Willis (anterior communicating artery)
151
Gold standard dx of berry aneurysm?
angiography
152
Txt for aneurysm?
surgical clipping, endovascular coiling within first 24 hours
153
Glasgow Coma scale of what is indicative of coma?
<9
154
What 3 things should be checked in a non responsive patient after ABCs?
Glucose (for low blood glucose levels)
Thiamine (Wernicke)
Narcan (opiates)
155
MC type of ischemic stroke?
Middle cerebral artery
156
Location of stroke when symptoms are greater in the leg, foot, and can cause urinary incontinence?
anterior cerebral artery
157
Location of stroke that causes vomiting, vertigo, visual changes?
Posterior cerebral artery
158
Location of stroke that causes sx in the face, arm?
middle cerebral artery
159
Txt for ischemic stroke?
alteplase (thrombolytic)
