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USMLE Step 3 MTB > Neurology > Flashcards

Flashcards in Neurology Deck (218)
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1

- sudden onset weakness on ONE side of body
- weakness of half of face
- aphasia
- +/- partial/total loss of vision

stroke, or TIA (transient ischemic attack)

2

stroke SPARES what part of face?

UPPER THIRD OF FACE

(from the eyes up)

3

80% of strokes are

ischemic (d/t thrombosis, or embolism)

4

20% of strokes are

hemorrhagic

5

symptoms last

TIA (transient ischemic attack)

6

transient loss of vision in one eye

amaurosis fugax

7

TIAs are ALWAYS caused by what? and are NEVER caused by?

- emboli, or thrombosis

- never hemorrhage

8

best INITIAL test for stroke or TIA

head CT WITHOUT contrast

9

how many days are needed to achieve > 95% sensitivity in detection of nonhemorrhagic stroke?

3-5 days

10

achieves 99% sensitivity for nonhemorrhagic stroke w/i 24 hours

MRI

11

can be positive for nonhemorrhagic stroke w/i 1 hour

MRA

12

treatment for stroke w/i 3 HOURS of onset of symptoms

thrombolytics

13

ABSOLUTE CI to thrombolytic therapy in a stroke pt (8)

- h/o hemorrhagic stroke
- intracranial mass
- active bleeding/surgery w/i 6 weeks
- bleeding d/o
- CPR w/i 3 weeks
- suspicion of aortic dissection
- stroke w/i 1 year
- cerebral trauma/brain surgery w/i 6 months

14

best INITIAL treatment for pts coming too late for thrombolytics, and AFTER use of thrombolytics

aspirin

15

treatment if pt develops stroke while already on aspirin

- switch to clopidogrel, or
- add dipyridamole to aspirin

16

should be added to ALL nonhemorrhagic strokes

statin

17

arterial lesions and symptoms:

- C/L PROFOUND LOWER extremity weakness
- mild upper extremity weakness
- personality changes, or psychiatric disturbance
- urinary incontinence

anterior cerebral artery

18

arterial lesions and symptoms:

- C/L PROFOUND UPPER extremity weakness
- APHASIA (can't speak)
- apraxia/neglect (inability to carry out purposeful movements)
- eyes deviate TOWARDS the lesion
- C/L homonymous hemianopsia

middle cerebral artery

19

arterial lesions and symptoms:

- prosopagnosia (inability to recognize faces)

posterior cerebral artery

20

arterial lesions and symptoms:

- vertigo
- N/V
- "drop attack," LOC
- VERTICAL nystagmus
- dysarthria (difficulty pronouncing words), and dystonia
- sensory changes in face and scalp
- ATAXIA
- B/L FINDINGS

vertebrobasilar artery

21

arterial lesions and symptoms:

- I/L FACE
- C/L body
- VERTIGO
- Horner's syndrome (doesn't have to be all 4 signs: miosis, ptosis, anhydrosis, and enophthalmos)

posterior inferior CEREBELLAR artery

22

arterial lesions and symptoms:

- MUST BE AN ABSENCE OF CORTICAL DEFICITS
- ataxia
- Parkinsonian signs
- sensory deficits
- hemiparesis (most notable in face)
- possible bulbar signs (impairment of CNs 9, 10, 11, 12)

lacunar infarct

23

arterial lesions and symptoms:

- amaurosis fugax

ophthalmic artery

24

after initial treatment of stroke/TIA, most important issue is to?

determine origin of stroke

25

the following are indicated in ALL pts with stroke/TIA

- echocardiogram
- carotid dopplers/duplex
- EKG/Holter monitor

26

the following are indicated in young pts (

- ESR
- VDRL, or RPR
- ANA
- ds-DNA Ab
- protein C
- protein S
- factor V Leiden mutation
- antiphospholipid syndrome

27

the younger the pt, the more likely the cause of stroke is from

vasculitis, or hypercoagulable state

28

treatment for status epilepticus

benzodiazepine

29

treatment for status epilepticus if seizure PERSISTS after use of benzodiazepine

add fosphenytoin

30

treatment for status epilepticus if seizure PERSISTS after use of benzodiazepine, and fosphenytoin

add phenobarbital