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NMSP II Exam 1 > Random Neuro ClinMed (Hon) > Flashcards

Random Neuro ClinMed (Hon) Flashcards

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1
Q

Who is Cryptococcal fungal meningitis most common in? (2)

A

immunocompromised or diabetic patients

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2
Q

What are the 3 first-line drugs used to treat bacterial meningitis?

A
  1. Vancomycin
  2. Ceftriaxone (3rd Gen cephalosporin)
  3. Steroids (Dexamethasone) –> prevent complications
  • do ASAP via IV –> do NOT delay treatment of patient
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3
Q

What are 5 common Infectious Encephalitis organisms commonly seen in adults?

A 
HSV 1 and 2
HIV
West Nile
Varicella Zoster
Treponema pallidum (Syphilis)

majority of pathogens causing encephalitis are viruses

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4
Q

Herpes Simplex 1 Encephalitis

Where is it located, what Abs are associated with it, and what is used to treat it?

A
  • focal abnormalities in TEMPORAL LOBE
    • headache, fever, impaired consciousness, seizures

Abs: NMDA autoantibodies –> secondary immune encephalitis

Tx: acyclovir

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5
Q

Autoimmune Encephalitis

What are they associated with, when does it commonly arise, and what are 4 treatment methods (I/P/R/C)?

A
  • associated with SEIZURE and intractable epilepsy
  • seen in pts. w/rapid (< 6wk) encephalopathy/psychiatric disturbances

Tx: IVIg, plasma exchange, RITUXIMAB, cyclophosphamide

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6
Q

NMDA Encephalitis

Who is it seen in, what are two labs that help diagnose it, and what presence is it associated with?

A
  • seen in young/middle-aged women

Labs: abnormal EEG with EXTREME DELTA BRUSH and NMDA receptor Abs (also pleocytosis/oligoclonal bands)

  • associated with the presence of a TERATOMA
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7
Q

LGI1 Encephalitis

Who is it seen in, how does it present, and what is required for treatment?

A
  • seen in men commonly

Sx: Faciobrachial Dystonic Seizures

  • same side face AND arm brief seizures
  • sleep disturbances, short-term memory issues

Tx: do NOT respond to antiepileptics; require IMMUNOTHERAPY
- 1/3 of pts RELAPSE

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8
Q

Which gender and from where is at inc. risk of MS?

What is seen on Lumbar Puncture?

A

Men > Women

Temperate Zones > Tropical Zone
- father from equator = inc. risk of MS

LP: oligoclonal bands and /or inc. IgG index/synthesis

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9
Q

What is seen on MS MRI?

A

MRI = ovoid lesions on T2W1 in periventricular WM and SC

- acute lesions get brighter with 2nd imaging

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10
Q

What 5 things are used in maintenance of MS (M/I/F/F/GA)

What is the only drug approved for Primary Progressive AND Relapsing/Remitting MS?

A
  • mAbs, interferons, fingolinmod, fumarates, Glatirimer Acetate
  • OCREVUS only drug for BOTH PP and RR MS
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11
Q

What two medications are used to treat ACUTE EXACCERBATIONS of MS?

A
  1. Methylprednisolone

2. ACTH (Acthar gel) or IVIg

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12
Q

Clinically Isolated Syndrome (CIS)

What is the difference between Monofocal and Multifocal?

What is another name for Multifocal Episode?

A

Monofocal: single neurological sign or symptom from a SINGLE lesion
- only happens ONCE

Multifocal: more than 1 neurological sign or symptom from lesions in MORE than 1 place
- only happens ONCE

Multifocal = Acute Disseminated Encephalomyelitis

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13
Q

Propranolol, primidone, clonazepam can be used to treat what in MS?

A

Intention Tremor

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14
Q

Devic’s Disease (Neuromyelitis Optica)

What is it, what are two labs that can help diagnose it, and how is it treated (R/S/PE)?

A
  • inflammation of demyelination of optic nerves/spinal cords
    • numbness/tingling/weakness/spasticity w/VISUAL issues

Labs: NMO (aquaphorin 4) and MOG Abs in blood/CSF

Tx: Rituximab, steroids, plasma exchange (ACUTELY)
- also azothiaprine/mycophenolate

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15
Q

What is Epilepsy?

A
  • 2 or more unprovoked seizures

Dx: made after 2 unprovoked seizures

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16
Q

Which epilepsy variant can be determined almost entirely on a SINGLE EEG?

A

Petit mal (w/HV) –> 90% positivity

% positive for ALL TYPES of epilepsy with 3 sleep-deprived EEFs = 85%

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17
Q

What is the single most important piece of information for diagnosis of epilepsy?

A

HISTORY of the events, preferably from an eye-witness

normal EEG does NOT exclude epilepsy presence

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18
Q

What is the difference between Myoclonic, Tonic, Clonic, and Atonic?

A

Myoclonic - brief jerks of extremities/trunk
Tonic - arms out front and extended
Clonic - jerking w/arms FLEXED
Atonic - go limp and fall down

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19
Q

What is the difference between these seizures:

  1. Simple Partial
  2. Complex Partial
  3. Secondary Generalized
A
  1. focal with no LOC; lasts seconds; NO post-ictal state
  2. nonresponsive staring w/possible aura preceding
    • 1-3 min; post-ictal state
  3. BILATERAL tonic-clonic activity; LOC; 1-3 min
    • post-ictal state
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20
Q

What is the difference between these Generalized seizures:

  1. Absence
  2. Tonic-Clonic
  3. Atonic
  4. Myoclonic
A
  1. nonresponsive staring, rapid blinks, chewing, LOC
    • 10-30 seconds, NO post-ictal state
  2. BILATERAL extension w/symmetrical extremity jerking
    • LOC; 1-3 min; post-ictal state
  3. sudden muscle tone loss, head drop, pt. collapse
    • LOC; post-ictal state
  4. brief, rapid symmetrical extremity/torso jerking
    • LOC; < few minutes; MINIMAL post-ictal state
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21
Q

What AED should NOT be given to pregnant women to treat seizures?

A

VALPROIC ACID

  • strongest Generalized seizure drug; VERY TERATOGENIC

synergistic with LAMOTRIGINE

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22
Q

What two AEDs are commonly used to treat seizures?

A

Leviteracetam and Lamotrigine

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23
Q

What is the only drug that is used for Absence Seizures?

A

Ethosuxamide

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24
Q

What is Status Epilepticus and what two drugs are commonly used to treat it?

If still seizuring after treatment with drugs, what should be done?

A

SE: prolonged seizure (> 10 min) or repeated seizures WITHOUT recovery in between

Tx: Benzodiazepine –> Leviteracetam (IV)

  • if unsuccessful –> midazolam/propofol IV (intubate pt before treatment)
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25
What is a major consideration of treating women of child-bearing age for seizures?
- should be on multivitamin with 1 mg. Folic Acid, as many of the AEDs are FOLATE-DEPLETING Tx: drug that pt. responds the MOST to
26
What is Transient Global Amnesia?
- sudden, temporary, isolated episode of memory loss with NO OTHER neurologic symptoms/signs - patient knows self/family/close friends, but may not recognize others - last hours then resolves (asks some question multiple times till out of seizure)
27
Why should Acute HTN in Ischemic Stroke NOT be treated?
- area of infarction may have lost autoregulatory function, so that 'normal' BP may be relatively HYPOtensive in the brain - lowering BP may inc. risk of damage to area around CORE of stroke
28
What do all stroke patients require and what should NOT be given to them?
- all stroke patients require IV access and IV fluids should NOT contain GLUCOSE (hyperglycemia = WORSE outcome) - get two IV access sites if tPa is considered
29
When should tPa be administered and is heparin useful for stroke patients?
- tPa should be started within at least 3-4 1/2 hours in acute ischemic stroke patients - heparin is NOT useful for acute ischemic stroke patients
30
What are two major scenarios where patients would need long-term anticoagulation therapy?
Atrial Fibrillation and Prosthetic Valves - also MI, ASD, hypercoagulable state - use WARFARIN, Dabigatran, Riveroxaban, Apixaban
31
What treatment of stroke has been shown to have improved outcomes compared to standard therapy?
Intra-arterial thrombolysis with clot reversal
32
What is the major difference in presentation between these Akinetic Rigid Syndromes: 1. Progressive Supranuclear Palsy 2. Multiple System Atrophy 3. Cortical Basal Degeneration
1. loss of VOLUNTARY control of eye movements - especially vertical gaze 2. PRONOUNCED autonomic dysfunction - EARLY vs Parkinsons Dz (late involvement) 3. sensory loss, apraxia, myoclonus, aphasia - CORTICAL involvement **see Lewy Bodies, bradykinesia, rigidity**
33
Syndenham's Chorea Who is it seen in, what does it cause, and how can it be treated?
- seen in children w/previous Group A Strep infection - causes UNILATERAL choreiform movements and behavioral changes Tx: bedrest and antibodies
34
What is the treatment Idiopathic Torsion Dystonia and Focal Torsion Dystonia?
ITD = low dose levodopa FTD = Botulinum Toxin injections - good use for Writer's Cramp
35
What is the definition of Gilles De La Tourette's Syndrome?
Chronic multiple motor and vocal tics with onset before the age of 21 yo
36
What is Essential Tremor?
- postural or kinetic tremor of both hands; can involve head or voice - not seen till later in life - alcohol and decrease tremor temporarily
37
What are the criteria for clinical diagnosis of Alzheimers Dz?
- deficits in 2+ areas of cognition with worsening memory and NO disturbance in consciousness - onset around 40-90 yo (usually after 65 yo)
38
What 2 categories of drugs are commonly used to slow Alzheimers Dz?
1. Acetylcholinesterase Inhibitors - DONEPIZIL | 2. NMDA Receptor Antagonist - MEMANTINE
39
What is the Tetrad of (Diffuse) Lewy Body Dz?
1. Dementia 2. Parkinsonism (NO TREMOR) 3. visual hallucinations/illusions (small animals/kids) 4. EXTREME antipsychotic sensitivity **psychotic symptoms are much more common and occur earlier than Alzheimers Dz**
40
How should Lewy Body Dz be treated?
- use newer antipsychotics, like quetiapine or olanzapine
41
CADASIL's Dz What age range does it affect, what is it caused by, and how does it present?
age range: 40-50 yo cause: hereditary stroke disorder from blood vessel smooth muscle degeneration - MRI = multiple areas of ischemia Sx: "migraine" headaches and TIAs/stroke - seen years prior to symptom onset
42
How do Visual, Labyrinthine, and Proprioceptive systems tell us about balance and body position?
Visual - distance Labyrinthine - acceleration/position change Proprioceptive - posture
43
What does the Romberg Test tell us about?
PROPRIOCEPTION
44
What is Benign Positional Vertigo?
- idiopathic; spontaneous recovery occurs frequently - brief recurrent episodes of vertigo triggered by changes in HEAD POSITION - debris floating in endolymph of any of the semicircular canals (POSTERIOR is most common)
45
What is the diagnosis of Benign Positional Vertigo confirmed by? What can help treat this issue?
Dix-Hallpike position testing - usually resolves spontaneously but positional exercise is helpful
46
What is Vestibular Neuronitis?
- spontaneous vertigo w/NO hearing loss and is NOT positional; acute N/V - peaks at 24 hrs and lasts days --> weeks - resolves spontaneously; steroids can help
47
What is Meniere's Dz?
- onset in 20-50 yo WOMEN due to inc. in volume of labyrinthine endolymph (POOR ABSORPTION) - recurrent spontaneous vertigo lasting > 20 min/< 24 hrs - LOW FREQUENCY hearing loss, tinnitus, aural fullness
48
What are two useful treatments for Meniere's Dz?
1. Sodium Restriction | 2. Diuretics: thiazides, furosemide
49
What is Mal de Debarquement?
illusion of movement as an after effect of travel, like sea - rocking/swaying feeling almost immediately after cessation of event
50
What are 5 common causes of Peripheral Drug Induced Disequilibrium? (A/Q/Abx/D/C)
- alcohol, Quinine compounds, Antibiotics, diuretics, chemotherapeutics
51
What is Friedrich's Ataxia?
- onset occurs before 20 yo with gait ataxia eventually of all 4 limbs; also muscle weakness and absent tendon reflexes - pts also have scoliosis, pes cavus, extensor plantar responses (UMN), and CARDIOMYOPATHY **NO TREATMENT AVAILABLE**
52
What is Ataxia-Telangiectasia?
- progressive limb/trunk ataxia ( < 4 yo) with oculocutaneous telangiectasia, and recurrent sinopulmonary infection/pneumonia (immune def.) - nystagmus/dysarthria also present - telangiectasia appear in teen years; immune def. due to dec. IgA and IgE antibodies
53
What two things does coma require?
**only needs one of these two, if not both** 1. bilateral hemispheric dysfunction 2. brainstem dysfunction (ARAS failure)
54
What two things are required for consciousness?
1. Arousal - alertness; interact with environment | 2. Awareness - know what's going on
55
What are the 3 'P's' of pinpoint pupils?
Pontine lesion oPiates Pilocarpine
56
By rule of thumb, what does an enlarged pupil on ONE side of a patients face usually indicate? What is the difference between Conjugate and Dysconjugate Roving eye movements?
parasympathetic dysfunction due to CN VIII issues - herniation can cause this ``` Conjugate = brainstem INTACT Dysconjugate = brainstem LESION ```
57
What eye movement is seen with Cold water irrigation to the ear with intact brainstem function?
Unilateral Ear --> eyes deviate to IRRIGATED side | Bilateral Ears --> eyes deviate DOWNWARD
58
What is the difference between Decorticate and Decerebrate positioning of Coma patients?
Decorticate - arms flexed, legs extended - HEMISPHERIC Decerebrate - all extremities extended - BRAINSTEM - more 'e's' = EXTENDED
59
What herniation leads to ipsilateral dilated pupils (compressed CN VIII), ptosis, and eventually contral lateral brainstem compression causing ipsilateral hemiparesis?
Uncal Transtentorial Herniation
60
What two things are associated with Cessation of Brain Function?
1. Unresponsiveness - no response to ALL sensory input, including pain/speech 2. Absent Brainstem Reflexes - use apnea test **only heartbeat remains**
61
What is the Apena Test?
- used to help determine Brain Death (GOLD STANDARD) - pt. is given 100% oxygen; pts. pCO2 lvls are allowed to rise to 60 mmHg - if respiratory responses are absent at 8-10 min, they are brain dead **get ABG before AND after test**

NMSP II Exam 1 (6 decks)

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