Shelf Review Questions Flashcards
eye finding in cavernous sinus thrombosis
extra ocular movement abnormalities
pizza fundus
central retinal vein occlusion- can present with TIA like episodes
risk of stroke in pts who have migraine with aura
OR 2.0-3.0
prevalence of PFO in general population
25% (this is higher ~ 35-50% in pts with unexplained stroke)
most common arteries affected in lateral medullary syndrome
vertebral > PICA
how to tx lateral medullary syndrome
heparin to prevent clot propagation
basilar occlusion causes what?
locked in syndrome
a mass in the cerebellopontine angle causes what?
issues with CN V, VII, VIII
an acute treatment for spinal injury is _______
IV mannitol
far lateral disk herniation at L4-5 could cause issues with which root
L4
- loss of patellar reflex
- weakness of foot dorsiflexion
- weakness of knee extension
- sensory loss in the calf
which nerve root is in charge of extensor hallicus longus (EHL)
L5
central disk herniation at L4-5 could cause issues with which root
L5 (EHL weakness)
2 causes of dorsal root ganglion disease
cisplatinum
anti-Hu paraneoplastic disease
what differentiates inclusion body myositis from polymyositis and dermatomyositis
inclusion body affects both proximal and distal muscles
-poly and dermato affect proximal muscles more
4 manifestations of diabetic neuropathy
distal small fiber
proximal amyotrophy
mononeuropathies single and multiplex
pupil sparing 3rd nerve
tx for GBS vs CIDP
GBS- plasmapheresis and IVIG
CIDP- steroids
copper deficiency causes neuropathy that mimics ________
B12 deficiency
familial neuropathy… think _______
Charcot Marie Tooth
anti-Hu paraneoplastic syndrome
paraneoplastic subacute sensory neuropathy and/or limbic encephalitis
-assoc with small cell lung cancer
weakness of biceps
absent biceps reflex
sensory loss to lateral aspect of velar forearm from wrist to forearm
lesion of musculocutaneous nerve
axillary nerve innervates which major muscle
deltoid
- radial nerve palsy but triceps strength is intact… where is the lesion
- radial nerve-sensory loss in the hand
- radial nerve- triceps are weak and they have crutches
- below the spiral groove
- at the wrist… most likely due to hand cuffs
- axilla
unexplained pain in extremity after remote injury
complex regional pain syndrome
- this is due to abnormal sympathetic response
- possible txs: sympathetic ganglion nerve block, sympatholytics (propranolol, prazocin, AEDs, TCAs)
transtentorial herniation with 3rd nerve palsy/lateral tenurial herniation is also known as _______
uncal herniation
comatose, vague dizziness, slurred speech –> unresponsive, ocular bobbing, pinpoint reactive pupils, absent VORs, quadriplegic… what is the insult?
basilar artery thrombosis
-in locked in, they would still be responsive
what might still be present in brain death?
DTRs
6 months of worsening bioccipital HA precipitated by running, sneezing, coughing, etc. in an older woman
chiari malformation and syrinx
“cough HA” –> needs decompression of the posterior fossa
treatment order for bacterial and tuberculous meningitis
dexamethasone –> abx –> CT –> LP
differential for hypoglycorrhacia (low glucose in CSF)
bacterial, cancer, TB!!!, neurosarcoidosis
meningococcal ppx
rifampin and cipro
bacterial meningitis 1 month-15 years
H flu –> meningococcus –> strep pneumo
bacterial meningitis 15-50 years
strep pneumo –> meningococcus –> staph
bacterial meningitis > 50 years
strep pneumo –> listeria –> gram negative rods
empiric tx for bacterial abx
ceftriaxone + ampicillin for listeria + vancomycin for staph
India ink identifies which organism
cryptococcus
nerve gas, organophosphate causes what
cholingergic toxicity
TCAs, urologic agents, benztropine causes what
anticholinergic
metaclopramide, other anti-emetics, antipsychotics, valproic acid causes what
extrapyramidal sxs
how to tx neuroleptic induced dystonia
anticholinergic
- benztropine
- diphenhydramine (benadryl)
- tetrabenazine
- trihexyphenidyl
chemo drug that causes leuko-encephalopathy
methotrexate
seizure about 1 week into admission is usually due to _____ withdrawal
benzo (except lorazepam)
-alcohol seizures usually occur in first 24 hours
hyperthermia, rigidity, rhabdo after antipsychotic (typical and atypical)
neuroleptic malignant hyperthermia caused by DA antagonism
med that commonly causes action tremor
lithium
familial ET treatment
propranolol or topiramate
cytarabine can cause _______ toxicity
cerebellar
which drug that treats neuropathic pain can cause urinary retention
TCAs
risk of seizure recurrence in a low risk patient
20-30%
AED + OCPs… what happens?
- lamictal
- gabapentin
- oxcarbazepine, carbamazepine
- topiramate
- lamictal: OCP drops lamictal levels
- gabapentin: no interaction
- oxcarbazepine, carbamazepine: these drop OCP levels
- topiramate: in large enough doses (>200mg), it can drop OCP levels as well
broad spectrum AEDs (3)
depakote/valproate- only this can be loaded quickly
topiramate
lamictal
which AEDs make generalized seizures worse?
carbamazepine, oxcarbazepine, phenytoin- these may precipitate childhood absence status epileptics
tx for absence seizures
ethosuximide
tx for REM behavior disorder
clonazepam
how to tx RLS
r/o iron deficiency
pramipexole or other direct DA agonist
associated with cerebral aneurysm and SAH
ADPKD
what must you give in a child s/p craniopharyngioma resection
hormone replacement therapy
alpha synuclein
Parkinson’s
tau proteins, amyloid beta
Alzheimer’s
superoxide dismutase
ALS
areas of abnormalities in Wernicke’s encephalopathy
mammillary bodies and periaqueductal grey matter
cause of incontinence in NPH
failure to inhibit voiding reflex
Cushing’s reflex
high blood pressure, decreased pulse… this suggests raised ICP. Tx with mannitol infusion and emergent operation
soft tissue sarcoma, white matter lesions, skin findings
NF I
what to give for delirium
haldol. .. possibly quetiapine in smaller populations
- reserve benzos for pts going through benzo/alcohol withdrawal, those with PD, and those with neuroleptic malignant syndrome
success rate with 3rd AED
5%
start considering surgery
low back pain with pretty much normal exam… what to do?
pain control and activity as tolerated
episodes of hypersomnia, hyperphagia, dissociative states lasting several days with normal inter-event behavior
Kleine-Levin syndrome
patients who respond well to AEDs with completely controlled seizures are good candidates for therapy discontinuation trial (T/F)
T
epileptics have a higher rate of suicide (T/F)
T
there is no difference in mortality between epileptics and normal ppl (T/F)
F
women with epilepsy have a reduced fertility rate (T/F)
T
what med treats prolactin producing adenomas
bromocriptine
diabetic pupil-sparing 3rd nerve palsy… what’s the prognosis
good… will likely recover R eye movement
stopping which med might cause irritability, anxiety, labile affect and loose associations with vivid dreams
SSRI withdrawal
why don’t you stop baclofen abruptly?
it can cause withdrawal seizures since it has GABA activity
one cause of pseudo tumor cerebra is _______
cerebral venous thrombosis… get an MRV
zaleplon (sonata), eszoplicon (lunesta)
non benzo sedatives
pramipexole
direct dopamine agonist for PD and for RLS
what do you give for dystonia?
diphenhydramine
tx bladder dysfunction
tolterodine, oxybutynin, solefenacin
how to tx vasospasm
nimodipine
tx dementia
rivastigmine, galantamine, memantine, donepezil
interferons, glatiramer, natalizumab, dalfampridine, fingolimod
MS drugs
tx alcohol withdrawal
chlordiazepoxide
Lamictal side effect (major one)
Stevens Johnson
Treatment for juvenile myoclonic epilepsy
Valproic acid (depakote)
