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Flashcards in 9. Neurology Deck (44)
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1
Q

sudden onset ipsilateral hyperacusis (Ear pain) + Complaining of waking up with Unilateral facial paralysis + uable to lift eye brow or forehead

Name/Risk/Nerve/PE/Tx

A

Name: Bell’s palsy

Risk: HSV

Nerve: CV7 (facial nerve)

PE: unable to wrinkle both side

Tx: Prednison (less than 72 hrs), artificial tear for lacrimation, Acyclovir

2
Q

hx of DM + numbness tingling at lower extremities

Name/Tx

A

Name: Diabetic neuropathy

Tx: Gabapentin for pain, DM control

3
Q

Ascending(leg first -> arm) weakness (usually symmetric) + DTR decreased + breathing difficulty

Name/Pathogen/Dx/Tx/contraindication/Complication

A

Name: Guillian Barre syndrome

Pathogen: Campylobacter Jejuni

Dx: CSF (protein high/Normal WBC)

Tx: Plasmapheresis, IVIG

  • Contraindicated Prednisone

Complication: Repiratory failure

4
Q

worsened with repetitive movement (worsen throughout the day/better with rest) + eye lid weakness + breathing problem

Name/Risk/PE/Dx/Tx

A

Name:MG (myasthenia gravis)

Risk: young women/Thymic abnormality

PE: DTR normal, respiratory muscle weakness

Dx

  • ACTH receptor antibodies
  • edrophonium (tensilon) test
  • ICE pack test (10 min on eyelid better)
  • Rule out CT or CXR for Thymoma

Tx

  • Pyridostigmine (1st)
  • IVIG/Plasmapheresis
  • Thymectomy
5
Q

Throughout the day weakness gets better + weight loss

Name/Related/Patho/Dx/Tx

A

Name: Lambert-Eaton

Related: SCC

Patho: antibodies against presynaptic voltage gated calcium channels prevents ACTH

Dx: electrophysiology

Tx: plasmapheresis (1st), remove tumor

6
Q

Bilateral tight band like (vise like) HA + No N/V + focal neurologic (photophobia)

Name/MC type HA/Tx/Prophylaxis

A

Name: Tension HA

MC common type: Tension

Tx: NSAID, acetaminophen

  • May be used for TCA, antimigrain med, BB for prophylaxis
7
Q

Unilateral HA + visusal change

Name/Risk/Type/Aura/caution/Tx/Prophylaxis

A

Name: Migraine HA

Risk: MC in Women

Type: classic (with aura), Common (without aura)

Aura: scotoma (blind spots), light flash

Caution: always remember focal neurologic problem possible Stroke

Tx: Triptans

  • CI: CAD, uncontrolled HTN or MI

Prophylaxis: BB, CCB, TCA, NSAID

8
Q

Unilateral HA + around eye pain + lacrimation

Name/Risk/Trigger/Tx/Prophylaxis

A

Name: Cluster HA

Risk: Males (young/middle age)

Trigger: ETOH, Worse at night

Tx: 100% O2, Triptan meds

Prophylaxis: Verapamil

9
Q

Meningitis Definition/MC/MC important/Less common/Age group

A

Definition: infection of membranes covering the brain and spinal cord

MC common: Viral

Most important: Bacterial

Less common: TB, Fungal

Age group Bacteria Pathogen

  • less than 1 month - GBS, lister
  • 1 mo - 18 yrs - N Meningitidis, H flu
  • 18yr - 50 yrs - S pneumo
  • 50 yr above - S pneumo, listeria
  • Farm worker, pregnancy - listeria
10
Q

Fever/chill + nuchal rigidity (stiff neck) + alter mental status

Name/PE/Dx/Tx/Prevention/Post exposure (alternate)

A

Name: Baterial meningitis

PE

  • Brudzinski - neck flex + knee hip flex
  • Kenig - can’t straighten knee when hip flexed

Dx: CT head (1st), LP (definitive)

Tx: Abx + Admiti ICU

  • neonate (less than 1 month) - cefo + ampicillin
  • 1 mon - 50y - ceftx + vanco
  • 50y above - ceftx + ampicillin + vanco
  • Dexamethasone - if strep pneumo (prevent hearing loss H flu)

Prevention: Hib, MCV

Post exposure: Cipro 500mg x 1 dose/alternate Rifampin

11
Q

Encephalitis vs viral meningitis

Define/Etiology/clinical menifestation/dx/tx

A

Encephalitis

  • Define: infection in Parenchyma
  • Etio: HSV
  • Clinical menifestation: lethargy, AMS, abnormal brain function
  • Dx: LP - high WBC, normal glucose
  • Tx: supportive care

Viral meningitis

  • Define: infection in Meninges
  • Etio: Enterovirus (coxackie)
  • Clinical emnifestation: HA, fever, Brudzinski & Kernig sign, Normal brain function
  • Dx: CSF - High WBC, Normal glucose
  • Tx: Supportive care
12
Q

Bacteria/Viral/Fungal CSF difference

A

Bacteria

  • Opening pressure high, Glucose low, Protein high, PMN (neurtrophil) high

Viral/Encephalitis

  • Opening pressure normal, Glocose normal, protein high, WBC high

Fungal

  • Opening pressure Normla or high, Glocose low, protein high, WBC high
13
Q

Hx of sinus infection or ear infection + HA + fever + neurologiccal finding

Name/Tx

A

Name: Cerebral abscess

Tx: Ceftx + Metronidazole + surgical drainage

14
Q

Tremor with movement and resolves at rest or drinking ethanol + often shaky voice + normal DTR and tone

Name/Risk/Tx

A

Name: Essential tremor

Risk: Elderly, MC movement disorder

Tx: Propanolol

15
Q

hx of father died in early + behavior change + dementia + Choreiform

Name/Patho/Dx/Tx

A

Name: Huntington’s disease

Patho: autosomal dominant (50% chance to get it if one of parent has it)

Dx: CT scan (caudate/cerebral nucleus atrophy)

Tx: none (die in 30-50), Benzo helpful

16
Q

Resting tremor + bradykinesia (slow movement) + rigidity (cogwheel) + fixed facial expression

Name/Define/Related/Tx

A

Name: Parkinson disease

Define: dopamin depletion

Related

  • lewybodies(misfolded protein - accumulation cause death)
  • loss of pigment cell seen in the substaintia nigra (contain lots of dopamin makes color - loss cell make depigment)

Tx: Levodopa/carbidopa

17
Q

Acutely Confused

Name/Risk/Tx

A

Name: Delirium

Risk: Dementia predisposition

Tx: Underlying cause (Lorazepam)

18
Q

Children with verbal tics (repeat phrase, throat clearing) or motor tics (blinking, shrugging, head thrusting, sniffling)

Name/Tx

A

Name: Tourette syndrome

Tx: habit reversal therapy (pimozide)

19
Q

Decline of memory overtime + elderly

Name/Related/Worsen comobid/Dx/Tx/Other dementia (4 type)

A

Name: Dementia

Related: MC alzheimer, vascular demntia(2nd)

Worsening: UTI, TSH

Dx: CT scan

Tx: Alzheimer - Donapezil, Vascular - ASA

Other dementia type

  • Alzheimer (1st)
  • Vescular (2nd) - launar infarcts
  • Frontotemporal dementia - localized brain degen (personality chang)
  • Lewybody - visual hallucination
20
Q

Uni eye pain + loss of color vision + babinski test upwards

Name/Patho/MC subtype/Risk/Dx/Tx

A

Name: MS (mutiple sclerosis)

Patho: autoimmune, inflammatory demyelinating disease

MC subtype: relapsing-remitting

Risk: 20-40 female

Dx: MRI - periventricle view shows white matter plaque, LP - IgG (oligoclonal bands) in CSF

Tx: Acute - IV corticosteriod, Plasmapheresis

  • relapsing-remitting - B- interferon
21
Q

Seizure classification 3 major with subtype explain

A
  • Partial (focal) seizure - hemisphere brain effect
    • Simple - remembers + sensory strange (taste problem) + jerking
    • Complex - doen’t remember + Automatisms (lip smacking, manual picking, patting)
  • General seizure - both hemisphere brain effect
    • Absense (petit mal) - childhood, brief staring eye twitching, loss and gain conciouseness (brief)
    • Tonic clonic - rigidity, jerking fall backword, LOSS CONCIOUSNESS
    • Myoclonic - short muscle twiching
    • Atonic - relaxed fall forward (loss of posture tone)
  • Status epilepticus - repeated gen seizure without recovery
22
Q

EEG shows 3 HZ spike wave

Name/Risk/Presents/Dx/Tx

A

Name: Absence seizure

Risk: young child (stop after 20)

Presents: Relaps of conciousness (lose and gain) + staring, eyelid twitching

Dx: EEG

Tx: Ethosuximide

23
Q

Treatment of seizures

A

Partial seizure - carbamazepine

General

  • absence - ethosuximide
  • grand mal, myclonic - vaproic acid
  • Epilepticus - lorazepam, diazepam -> phenytoin -> phenobarbital
24
Q

Mixed upper and lower motor neron signs + sensation, urinary spincter, voluntary eye movement are spared

Name/Tx

A

Name: ALS (amyothrophic lateral sclerosis)

Tx: Riluzole (reduce progressive upto 6month) fatal in 3-5 years

25
Q

burning sensation at leg + Worse at night + improve with movement

Name/Tx

A

Name: Restless legs syndrome

Tx: dopamin agonists (pramipexole,Ropinirole)

  • Iron supplement (check ferritins level lower than 75)
26
Q

hx of birth defect (limb-length discrepancies) + intellectual/learning disabilities

Name/PE/Tx

A

Name: Cereberal palsy

PE: hyperreflexia

Tx: multidisciplinary approach, improve spasticity - diazepam

27
Q

facial burning, pain with wind blowing, touch, eating

Name/Tx

A

Name: TGN (trigeminal neuralgia)

Tx: carbamazepine

28
Q

HA + visual change + papilledema + CT scan no mass found

Name/Dx/Tx

A

Name: idiopathic intracranial HTN

Dx: CT(1st) -> LP - increased pressure with normal glucose

Tx: acetazolamide

29
Q

Dementia + gait disturbance + urinary incontience + MRI large venticle + No abnormal CSF

Name/define/Tx

A

Name: Normal pressure hydrocephalus

Define: dilation of the cerebral without abnormal CSF

Tx: Ventriculoperitoneal shunt

30
Q

Sport activities with loss of conciouse + confusion + amnesia

Name/Dx/Tx

A

Name: Concussion syndrome

Dx: CT (1st for acute), MRI for 7-14 days event/worsening sx

Tx: Cognitive & physical activities rest

  • if sx resolved they can resume activities - if more than 3 consecutive concussion must stop activities for whole season
31
Q

Vertical compression accident vs hyperextension of the skull accident

Name/Dx/Tx

A
  • Vertical compression - C1 fx (jefferson)
    • Dx: Lateral X-ray (open mouth view)
    • Tx: non op - collar x 6-12 wks
  • hyperextend - C2 fx hangman
    • Dx: CT scan
    • Tx
      • less than 3mm displace collar 4-6week
      • 3-5mm displace close reduction
      • more then 5mm displace OP
32
Q

hx of atherosclerosis + BP difference between arms

Name/Dx/Tx

A

Name: subclavian steal syndrome

Dx: CT angio

Tx: revascularization

33
Q

Spinal cord injury

Mechanism of injury/deficit

A
  • Anterior cord
    • Mechanism of injury: direct compression (blow out vertebral body burst)
    • Deficit - lower > upper (bladder dysfunction)
  • Central cord
    • Mechanism of injury: Incomplete cord syndrome, hyperextension MVA
    • Deficit: upper > lower (shawl distribution)
  • Posterior cord
    • Mechanism of injury: rare
    • Deficit: loss of proprioception & vibratory sense only (normal temperature and no pain)
  • Brown sequard
    • Mechanism of injury: stabbing trauma (unilateral damage)
    • Deficit
      • Ipsilateral - motor, vibration & proprioception problem
      • contralateral - pain & loss of temp
34
Q

Brain damage left vs right side, broca vs wernicke

A
  • Left - dominant (speech language) right side weakness, sensory
  • right - nondominant (flat affect, impaired judgment), left side weakness, sensory
  • Broca apasia - difficulty speaking with comprehension ability
  • Wernicke apasia - difficulty speaking with no comprehension ability
35
Q

sudden weakness of extremity + amaurosis fugax (monoocular vision loss) + recovers after couple hours(less than 24 hrs)

Name/Risk/PE/Dx/Tx/Contraindication

A

Name: TIA (transient ichemic attack)

Risk: DM, HTN, aFib

PE: Amaurosis fugax

Dx: CT scan

Tx: ASA + clopidogrel

  • Thrombolytic contraindicated
36
Q

Stroke location

  1. MC stroke location?
  2. Face and arm
  3. Leg and foot + face spared
  4. crossed sx (visual hallucination)
  5. Stroke Dx?
  6. Stroke Tx?
A
  1. lacunar infarct
  2. middle cerebral artery
  3. anterior cerebral artery
  4. Posterior cerebral artery
  5. CT noncontrast
  6. Thrombolytic in 3 hours (alteplase) CI: 185/110 or any recent bleeding
37
Q

temporal bone fx + convex on CT

Name/location/Dx/Tx

A

Name: Epidural hematoma

Location: arterial bleed (between skull and dura)

Dx: CT (convex, do not cross suture line)

Tx: small observe, ICP high - mannitol

38
Q

blunt trauma + Concave on CT

Name/location/Dx/Tx

A

Name: subdural hematoma

Location: venous bleed (bridge vein)

Dx: CT concave (cross suture line)

Tx: Supportive

39
Q

Thunderclap + worst HA of my life

Name/Dx/Tx

A

Name: SAH (subarachnoid hemorrhage)

Dx: CT first none then DO, LP (high open pressure + RBC or xanthocromia), Confirm by 4 vessel angiography

Tx: Nicardipine, nimodipine (gradual BP drop)

40
Q

hx of HTN + HA, N/V + CT shows bleeding

Name/Dx/Tx

A

Name: ICH (intracerebral hemorrhage)

Dx: CT (intraparenchymal bleed), DO NOT perform LP (may cause herniation)

Tx: Supportive (ICP high - mannitol)

41
Q

Sensitive touch (cold) + Burning thrombing pain and swelling at extremities (arm & leg) + hx of stroke, injuries site (4-6weeks ago)

Name/History/Tx/Prevention

A

Name: Complex regional pain syndrome

History: 4-6 weeks after fx or surgery

Tx: PT (1st) + NSAID, gabepentin

Prevention post fx: vitamin C helpful to prevent

42
Q

Recurrent HA in children + seizure + intracranial hemorrhage in image

Name/Patho/Dx/Tx

A

Name: AV malformation

Patho: Artery to vein transfer without passing capillary system

Dx: MRI(initial), X-ray angiography (gold)

Tx: Neurosurgery referral

43
Q

Mad cow disease caused by what?

A

Prion

44
Q

EPS 4 type sx and tx

A

Typical > atypical antipsychotics

Acute dystonia: muscle spasms, stiffness, oculogyric crisis, tx: benztropine, dyphenhydramine

Akathisia: restlessness, tx: benztropine

Bradykinesia: Parkinsonism, tx: benztropine

Tardive dyskinesia:orofacial involuntary movements, Tx: Stop offending agent