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Flashcards in Neurology_MTB 2 Deck (74):
1

SAH Tx?

No Tx can reverse hemorrhage
1. Nimodipine - prevents subsequent ischemic stroke
2. Embolization - prevent repeated hemorrhage
3. VP shunt - if ass'd w/ hydrocephalus
4. Phenytoin - Seizure proph (controversial)

2

Dx?
- Loss of all fx except position & vibratory sensation below a specific spinal level

ASA infarction (Posterior Column intact)

3

How does ASA infarction present?

- Loss of all fx except Post Column
- Flaccid paralysis below level of infarction
- Loss of DTRs & level of infarction

- Evolves into spastic paraplegia several wks later
- Loss of pain & temp
- Extensor plantar response

4

Subacute Combined Degeneration of the Cord: causes?

B12 deficiency or Neurosyphilis

Pres: Position & vibratory sensation are lost

5

Spinal Trauma Tx?

Glucocorticoids

6

Syringomyelia: most accurate test?

MRI

7

Syringomyelia: best treatment?

Surgical removal of tumor if present & drainage of fluid from the cavity

8

Brain abscess can spread from where/what?

- Can spread from a contiguous infection in the sinuses, mastoid air cells, or otitis media
- Anything that leads to bacteremia (Pneumonia, Endocarditis)

9

Brain abscess presentation?

Headache, nausea, vomiting, fever, seizures, focal neurological deficit
(same as brain tumor)

10

Brain abscess: best initial test?

head CT or MRI

(still must always biopsy to diff. from tumor)

11

Brain abscess: most accurate test?

Biopsy

12

Duration of ABX Tx in brain abscess?

6-8 weeks IV, followed by 2-3 more months orally

13

Brain abscess: empiric Tx?

Penicillin (or Vanco) + Metronidazole + Ceftriaxone (or Cefepime)

14

Essential Tremor: best therapy?

Propranolol

(classic pres: tremor improves w/ drink of alcohol)

15

Parkinsonism: definition?

Loss of cells in Substantia Nigra resulting in a dec in dopamine
- results in mvmt disorder p/w tremor, gait disturbances, & rigidity

16

Parkinsonism causes?

- Idiopathic (most common)
- Repeated head trauma
- Antipsychotic meds (Thorazine)
- Encephalitis
- Reserpine
- Metoclopromide

17

Parkinson mild disease:
Tx?

- Benztropine or Trihexyphenidyl (anti-ACh) -- relieve tremor & rigidity

- Amantadine -- inc's DA release from SN

18

Benztropine - MOA?

Anticholinergic medication used in Parkinson's to relieve tremor & rigidity

19

Benztropine - AEs that occur more frequently in the elderly?

- Dry mouth
- Worsening prostate hypertrophy
- Constipation

20

Trihexyphenidyl - AEs that occur more frequently in the elderly?

- Dry mouth
- Worsening prostate hypertrophy
- Constipation

21

What to use in mild Parkinsons in elderly who are intolerant of anticholinergics?

Amantadine (inc's DA release from SN)

22

Amantadine - MOA?

Increases DA release from the Substantia Nigra

23

Best initial Tx in severe Parkinsonism (pt unable to eat or care for themselves)?

Pramipexole & Ropinirole
-- non-ergot DA agonists
(these are better than Bromocriptine, an ergot DA agonist)

24

Most effective Tx in severe Parkinsonism (pt unable to eat or care for themselves)?

Levodopa/Carbidopa

25

Tx that extends the duration of Levodopa/Carbidopa?

Tolcapone, Entacapone (COMT inhibitors)
-- block metabolism of DA

26

Rasagiline - MOA?

MAO inhibitor -- blocks metabolism of DA

- use w/ Levodopa/Carbidopa or as a single agent

27

Selegiline - MOA?

MAO inhibitor -- blocks metabolism of DA

- use w/ Levodopa/Carbidopa or as a single agent

28

Non-pharma Parkinson's Tx that is highly effective for tremors & rigidity in some patients?

Deep Brain Stimulation

29

Which medication is capable of slowing the progression of Parkinson's?

MAO inhibitors are the only ones that can actually slow progression of the disease (b/c they prevent breakdown of DA)

30

When might you use Clozapine in Parkinson's?

If they start having Psychosis & confusion symptoms
(b/c you cannot take them off anti-Parkinson meds even if these are the cause)
- Clozapine good b/c it's a neuroleptic w/ few extrapyramidal (anti-dopaminergic) effects

31

w/ what meds do you have to avoid Tyramine-containing foods (i.e. cheese)?

MAO inhibitors

32

Dx?
Parkinsonism + Dementia?

Lewy Body Disease

33

What is Lewy Body Disease?

Parkinsonism + Dementia

34

What is Shy Drager Syndrome?

Parkinsonism predominantly w/ Orthostasis

35

Dx?
Parkinsonism predominantly w/ Orthostasis

Shy Drager Syndrome

36

Baclofen MOA?

GABA receptor agonist
(muscle relaxant -- use for spasticity)

37

Dantrolene MOA?

Prevents Ca2+ release from SR of skeletal muscle
(muscle relaxant -- used for spasticity & neuroleptic malignant syndrome)

38

Restless Leg Syndrome - Tx?

Dopamine agonists
(Pramipexole)

39

Spasticity (often ass'd w/ MS) - Tx?

- Baclofen
- Dantrolene
- Tizanadine (centrally-acting alpha-agonist)

40

Huntington genetic defect?

CAG trinucleotide repeats on Chromosome 4

41

Huntington Disease -- Dyskinesia is treated w/ what?

Tetrabenazine

42

Huntington Disease -- Psychosis is treated w/ what?

Haloperidol, Quetiapine, or a triad of different antipsychotics

43

What does head CT or MRI show in Huntington Disease?

Caudate Nucleus involvement

44

Tourette Disorder Tx?

Fluphenazine, Clonazepam, Pimozide, or other neuroleptic meds

45

Most common presentation of MS?

Focal sensory symptoms, w/ gait & balance problems
(blurry vision or visual disturbance from optic neuritis no longer most common pres)

46

What is Internuclear Opthalmoplegia (INO)?

Inability to adduct one eye w/ nystagmus in the other eye
(characteristic of MS)

47

MS - best initial test?

MRI

48

MS - most accurate test?

MRI

49

Which MS medication is ass'd w/ development of Progressive Multifocal Leukoencephalopathy?

Natalizumab
(inhibitor of alpha-4 integrin)

50

ALS presentation

Upper & motor neuron lesions

(NO sensory loss)

51

ALS -- which medication reduces glutamate buildup in neurons & may prevent progression of disease?

Riluzole

52

Riluzole - MOA?

Reduces glutamate buildup in neurons & may prevent progression of disease in ALS

53

ALS - Tx?

- Riluzole - reduces glutamate buildup in neurons & may prevent progression of disease
- Baclofen treats spasticity
- CPAP & BiPAP help w/ resp difficulties 2/2 muscle weakness
- Tracheostomy & maintenance on ventilator often necessary when disease advances

54

Charcot-Marie-Tooth Disease

Genetic disorder:
- Distal weakness & sensory loss
- Wasting in legs
- Decreased DTRs
- Tremor
- Foot deformity w/ high arch common

**NO Tx exists

55

Peripheral Neuropathy - causes?

- Diabetes Mellitus (most common)
- Uremia
- Alcoholism
- Paraproteinemias like MGUS

56

Peripheral Neuropathy - Tx?

Pregabalin or Gabapentin are best initial Tx

- TCAs & most seizure meds are helpful in some ppl

57

How to distinguish Stroke vs. Bell's Palsy?

Stroke - patient can wrinkle forehead on affected side (lower 2/3 face paralysis)

Bell - patient cannot wrinkle forehead on affected side (total face paralysis)

58

Bell's Palsy symptoms?

- Paralysis of entire half of the face

- Hyperacusis - Sounds are extra loud b/c Stapedius acts as "shock absorber" of middle ear

- Taste disturbances in ant. 2/3 of tongue

59

Guillain Barre -- CSF analysis?

Increased protein w/ a normal cell count

60

GBS -- Tx?

IVIG or Plasmapheresis
(but do NOT combine them)

61

Myasthenia Gravis PE?

"Double vision & difficulty chewing"

PE = Ptosis, weakness w/ sustained activity, & NORMAL pupillary responses

62

Myasthenia Gravis -- best initial test?

ACh receptor antibodies (80%-90% sensitive)

- if neg, get anti-MUSK (muscle-specific kinase) antibodies

63

Edrophonium - MOA?

Short-acting acetylcholinesterase-inhibitor

- temporarily bumps up ACh levels, improving motor fx as dx test in Myasthenia Gravis

64

Myasthenia Gravis - most accurate test?

Electromyography shows decreased strength w/ repetitive stimulation

65

What imaging should be done in Myasthenia Gravis & why?

Chest x-ray, CT, or MRI
- to look for Thymoma or Thymic hyperplasia
- CT w/ contrast is best

66

Myasthenia Gravis -- best initial Tx?

Neostigmine or Pyridostigmine
- longer acting versions of edrophonium

67

If initial Tx fails in Myasthenia Gravis, what next?

if < 60 yrs = Thymectomy

if > 60 yrs = Prednisone, then Azathioprine, Cyclophosphamide, or Mycophenolate before serious steroid effects occur

68

Acute Myasthenia Gravis management?

IVIG or Plasmapheresis

69

Azathioprine -- MOA?

Antimetabolite precursor of 6-mercaptopurine that interferes w/ metabolism & synthesis of nucleic acids (AKA purine analog)

- Toxic to proliferating lymphocytes
- used in Leukemia

70

Azathioprine - Adverse effects?

- Bone marrow suppression

- Toxic effects inc'd by Allopurinol b/c its active metabolite mercaptopurine is metabolized by xanthine oxidase

71

4 Nitrosurea drugs

Carmustine, Lomustine, Semustine, Streptozocin

72

Nitrosureas: clinical use?

Brain tumors
(including Glioblastoma Multiforme)

73

Nitrosureas: MOA?

DNA Alkylation (x-links DNA strands)
- require bioactivation
- cross BBB into CNS

74

Nitrosureas: AEs?

CNS toxicity
(dizziness, ataxia)