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PANCE review > Neuro > Flashcards

Neuro Flashcards

1
Q

primary vs secondary HA

A

primary HAs are recurrent and benign. Secondary is new onset and life threatening

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2
Q

What HA is frequency and bilateral and most common HA

A

tension HA

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3
Q

What HA is unilateral, aura, recurrent, associated with periods.

A

migraine

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4
Q

You are thinking migraine, but you find focal neurological findings, what must be ruled out?

A

stroke

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5
Q

patient can’t stay still, male patient, horrible pain, tearing, sweating, ptosis and miosis, all symptoms are unilateral, what type of HA

A

Cluster

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6
Q

thunder clamp HA

A

subarachnoid

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7
Q

tx for HA

A

dopamine agonist (

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8
Q

route to giving medications for HA

A

IV is faster than IM, IM is faster than oral

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9
Q

treat for HA

A

O2(higher concentration the better) or intranasal lidocaine

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10
Q

HA preventions

A

Antidepressants, anticonvulsants, Antihypertensives

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11
Q

Ischemic stroke is what color on CT

A

black

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12
Q

hemorrhagic stroke is what color on CT

A

white

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13
Q

What type of stroke is known for headache?

A

hemorrhagic

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14
Q

sudden onset of L arm, what artery

A

right side middle cerebral artery

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15
Q

sudden onset of L leg, what artery

A

right side anterior cerebral artery

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16
Q

treatment for hemorrhagic stroke

A

ABC, lower BP, reverse anticoagulopathy, Lower ICP.

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17
Q

how do you lower ICP with hemorrhagic stroke

A

mannitol, hyperventilation, burr hole

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18
Q

ischemic stroke management

A

ABC, Fibrinolysis (break up clots), Lower ICP

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19
Q

general stroke management (ischemic)

A

head of bed at 30 degrees, NPO, bed rails up, ASA, (allow BP to be a little high in ischemic stroke), no hypotonic fluids, control fever, control blood sugar, stop from getting blood clots.

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20
Q

what are the five Ds of a posterior stroke?

A

Dizziness (vertigo)

  • Diplopia
  • Dysarthria
  • Dysphagia
  • Dysmetria
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21
Q

one side of the face and the opposite side of the body if affects. where is the stroke?

A

posterior circulation / vertebral/basilar system

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22
Q

A patient presents with the ability to produce fluent speech, though the words and sentence structures do not make sense. In which of the following areas of the brain is the defect occurring?

A

Wernicke’s aphasia (’Receptive aphasia’) occurs when the area of the brain that organizes speech is affected. The patient retains the ability to produce speech, but is unable to organize it into comprehensive language.

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23
Q

patient presents with loss of the left visual field in each eye. What is the most likely location for the lesion

A

Lesions in the right optic tract will cause a left homonymous hemianopsia.

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24
Q

most common cause of subarachnoid hemorrhage

A

aneurysm due to HTN

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25
Q

worse/different headache of life, presented with syncope

A

subarachnoid hemorrhage

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26
Q

get a sentinel headache (initial) than get better

A

subarachnoid hemorrhage

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27
Q

how do you dx subarachnoid hemorrhage

A

CT (if negative use LP there will be blood) if either is positive =surgery

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28
Q

what level of spine is LP done

A

L2 (b/c cord ends)

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29
Q

xanthochromia

A

bright red blood cells in CF, positive for subarachnoid hemorrhage

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30
Q

tx of subarachnoid hemorrhage

A

control: pain, bp, reverse blood thinners, control seizures. Bleed blocks CF drainage can cause hydrocephalus

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31
Q

best study to see damage of TIA

A

advanced imagining

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32
Q

tx for TIA

A

aspirin, carotid endarterectomy (>70% blockage), anticoagulant

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33
Q

patient has TIA, look at what PE finding

A

carotid bruit and a fib on ECHO

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34
Q

what is Bell’s Palsy? what nerve

A

unilateral facial palsy without other symptoms, CN VII.

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35
Q

what causes Guillian Barre

A

immunizations (flu vaccine) GI illness (camptobacyter)

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36
Q

cannot wrinkle forehead is this bell’s palsy or stroke

A

bell’s palsy (cannot close eye, wrinke forehead, ear pain before palsy, lacrimation)

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37
Q

tx of bell’s

A

acyclovir and steroids

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38
Q

DM neuropathy

A

is symmetrical weakness in lower legs

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39
Q

symmetric bilateral lower extremity weakness that is ascending 2-4 weeks after benign illness, then progressive, symmetric, distal to proximal lower extremity weakness over 2 weeks

A

Guillian Barre

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40
Q

worse complication of Guillian Barre

A

diagram weakness and Autonomic: cardiac, urinary retention

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41
Q

LP on Guillian Barre will show

A

elevated protein

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42
Q

tx for Guillian Barre

A

plasmapheresis and IV immunoglobin

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43
Q

myasthia gravis hallmark

A

improves with rest and ptosis gets worse throughout the day, worry about diaghramic weakness

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44
Q

dx of myasthia gravis

A

edrophonium test

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45
Q

you suspect myasthenia gravis, what must be ruled out and how

A

thymona on chest xray

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46
Q

anti acetylcholine receptor test antibodies

A

is positive in 90% of myasthenia gravis patient

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47
Q

tx of myasthia gravis

A 
cholinesterase inhibitors (pyridostigmine), corticosteroids,
immunosuppressive agents, IVIG, plasmapheresis
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48
Q

what is Lambert-Eaton?

A

uncommon disorder of neuromuscular junction

transmission with the primary clinical manifestation of PROXIMAL muscle weakness. defective release of acetylcholine

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49
Q

what cancer is Lambert-Eaton associated with

A

small cell

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50
Q

proximal muscle power increases with sustained contraction as day goes on

A

Lambert-Eaton

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51
Q

Dx of Lambert-Eaton

A

Dx: electrophysiologic studies

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52
Q

tx of lambert eaton

A

Tx: plasmapheresis, immunosuppressive therapy, tumor treatment

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53
Q

pregnancy ladies get what type of meningitis

A

listeria

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54
Q

Neonates get meningitis from

A

Group B Strep., E. coli, Listeria

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55
Q

2 months to 6 years get what type of meningitis

A

2 months to 6 years: Strep pneumonia, H. flu Type B, Neisseria
meningitidis

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56
Q

greater than 6 including adults get what type of meningitis

A

Greater than 6 years: Strep pneumonia, Neisseria meningitidis

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57
Q

Brudzinski’s sign:

A

flexion of knees with flexion of the head

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58
Q

Kernig’s sign:

A

head flexion when the knees are flexed and then the leg is extended
○ Mnemonic: K = Knees

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59
Q

dx meningitides, must get what before LP

A

get CT scan

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60
Q

findings in LP with bacteria meningitis

A

low sugar

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61
Q

tx of meningitis for age Less than 8 wks age

A

Ampicillin + Cefotaxime (or Aminoglycoside)

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62
Q

antibiotic used for listeria

A

Ampicillin

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63
Q

Greater than 3 mo (and adults) tx for meningitis

A

Ceftriaxone + Vancomycin

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64
Q

treatment Immunocompromise/Chronic EtOH/>50 yrs with meningitis

A

Ampicillin + Ceftriaxone + Vancomycin

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65
Q

Head trauma/VP shunt/CNS surgery: tx for meningitis

A

Vancomycin + Ceftazadime

66
Q

decreases deafness related to H. flu

A

Dexamethasone

67
Q

admit bacteria or viral meningitis

A

bacteria

68
Q

treat close contact if patient is treated with meningitis with?

A

Ciprofloxacin, Rifampin, Ceftriaxone

69
Q

Waterhouse-Friderichsen syndrome

A

complication of adrenal failure due to meningitis

70
Q

prevention of meningitis

A

Haemophilus influenzae type b (Hib)
Pneumococcal conjugate vaccine (PCV7)
Pneumonococcal polysaccharide vaccine (PPSV)
Meningococcal conjugate vaccine (MCV4)

71
Q

encephalitis is…….

viral or bacterial

A

Infection of brain parenchyma causing destruction of neurons, Usually caused by viruses
○ HSV1, HSV2, Varicella, Equine, West Nile, HIV, Measles, Rabies

72
Q

dx encephalitis

A

CT head, Lumbar puncture: Viral and bacterial cultures, antigen tests, MRI: classic temporal lobe pattern
Brain Biopsy

73
Q

tx of encephalitis

A

Antiviral medications: e.g., acyclovir, foscarnet
Empiric antibiotics for bacterial meningitis
● Antiepileptics
● Steroids: e.g., dexamethasone
● Supportive care (these are sick people!)

74
Q

do encephalitis need to be admitted

A

YES, ICU

75
Q

bacterial LP

A

glucose low, elevated pressure and high protein

76
Q

viral LP

A

Lymphocytes (everything else is normal)

77
Q

TB LP

A

high protein

78
Q

encephalitis LP

A

normal pressure, normal glucose and protein

79
Q

ring enhanced lesion with focal neurologic finding

A

brain abscess

80
Q

things that cause brain abscess

A

Usually bacterial, can be fungal
● Direct spread: Sinus infection, ear infection
● Emboli: Endocarditis, cyanotic congenital heart disease
● Treatment: long term antibiotics and surgical drainage

81
Q

parkinsons is the loss of

A

dopaminergic neurons

82
Q

treatment of parkinson’s

A 
Levodopa (supplement dopamine) plus carbidopa (stops breakdown of levodopa)
○ Side effects: dyskinesias
● MAO-B inhibitors: well tolerate
Anticholinergics
deep brain stimulator
83
Q

Myasthenia Gravis associated with

A

associated with thymus tumor → thymoma

84
Q

signs and symptoms of MG

A

Proximal weakness – repeated movements (brushing hair)
● Fatigue
● Ptosis, Diplopia
● Dropping head

85
Q

dx of MG

A

“Tensilon test” (edrophonium), stops breakdown of Ach, pt will have increased strength

86
Q

other physical and lab test that help dx MG

A

Fatigability test: continued upward gaze leads to ptosis, relieved with rest
● “Ice pack test” ptosis should improve with cold
● Antibodies to Ach receptors
● “Tensilon test” (edrophonium), stops breakdown of Ach

87
Q

what disorder is similar to MG but no weakness and patient has lung cancer

A

Lambert Eaton

88
Q

treatment of MG

A

Acetylcholinesterase inhibitors: neostigmine, pyridostigmine
● Immunosuppressants: prednisone, azothioprine
● IgG plasmapharesis
● Thymectomy → can improve even without thymoma

89
Q

huntington’s disease is genetic auto dominant or recessive

A

dominant 50% of offspring get it!

90
Q

what is Huntington’s dz

A

Degeneration and loss of neurons with atrophy in caudate nucleus/putamen

91
Q

symptoms of huntington’s dz

A

Psychosis usually predominates
○ Antisocial/poor impulse control
movement disorder and dementia

92
Q

tx of huntingston’s

A

Tetrabenzanine: depletes monoamines and antidepressants and antipsychotics

93
Q

categories of of Glascow coma

A

motor, verbal, eye opening

94
Q

highest GC score and lowest

A

15 and 3

95
Q

presentation of 2 types of Brainstem hemorrhage

pontine and cerebellar

A

Pontine: pinpoint pupils
Cerebellar: extensor posturing, lost papillary reflex

96
Q

Herniation syndromes

two types uncial herniation and central herniation(this is worse)

A

Uncal herniation: dilated, non-reactive ipsilateral pupil

○ Central herniation: loss of brain stem reflexes, decorticate posturing and irregular respirations

97
Q

Pseudocoma test

A

Nystagmus with caloric vestibular testing (freezing cold water in pt’s ear)

98
Q

Consider ICP protection with

A

mannitol or hypertonic saline

99
Q

types of delirium

A

Hyperactive: withdrawal or intoxication (EtOH, drugs)
● Hypoactive: Hepatic encephalopathy, hypercapnia
● Mixed: Daytime sedation, nocturnal agitation

100
Q

visual hallucinations, must rule out

A

acute delirium

101
Q

medications that can help or exacerbate delirium

A

Rivastigmine, haldol, ativan, propofol

102
Q

Vascular dementia dffers from other dementia by…

A

gait or deep tendon reflex abnormalities

103
Q

Changes in tau protein → causes neurofibrillary tangles, senile plaques and atrophy is what disorder?

A

Alzheimer’s Disease

104
Q

Alzheimer’s Disease risk factors

A

age, Down’s syndrome, family history, HTN, insulin resistance, obesity

105
Q

autoimmune antibodies → inflammatory demyelinating polyneuropathy → delayed nerve conduction → symmetric ascending weakness paralysis

A

Guillian Barre

106
Q

hallmark of Guillian Barre syndrome

A

Poor to absent reflexes

107
Q

Lumbar Puncture shows Elevated protein > 400mg/dL in 90%, ascending weakness and decreased nerve conduction studies or muscle biopsy.

A

Guillian Barre.

Dx Gold standard is nerve conduction and muscle biospy

108
Q

treatment of autonomic symptoms of guillian barre

A 
Treat autonomic symptoms
○ Bradycardia → atropine
○ Hypertension → nitroprusside or beta blocker
○ Hypotension → IVF
○ Heart block → temporary pacing
109
Q

medical treatment of GB (guillian barre)

A

IVIG or plasma exchange proven to shorten recovery by 50% but Steroids alone do not work

110
Q

MS is know for migratory and chronic symptoms name some of the migratory symptoms

A 
Sensory loss 
Cerebellar sx (dysarthria, ataxia, tremor) Heat intolerance
Motor spinal cord sx 
Optic neuritis, Muscle spasticity, 
Lateral gaze diplopia 
Bladder dysfunction, constipation
111
Q

Optic neuritis with MS

A

painful vision loss, color perception is altered, disc looks normal, usually unilateral, flashes of light (phosphrenes)
retrobulbar pain

112
Q

dx of MS

A

McDonald Criteria :Clinical scoring system + MRI + CSF
Lumbar Puncture :Oligoclonal band pattern on electrophoresis
● MRI
○ Atrophy and “black holes” signify axonal death

113
Q

tx for acute exacerbation of MS

A

steroids

114
Q

chronic treatment for MS

A

Interferon, immunosuppressives

115
Q

symptom control MS

A

Symptom control

○ amantadine (fatigue), baclofen (spasticity), Aricept

116
Q

Dx for MG

A

Anti-AChR antibody positive in 75%, Antistriated muscle Ab

Anti muscle-specific receptor tyrosine kinase

117
Q

MG is associated with?

A

Associated w/ autoimmune dx (commonly hypothyroid) and thymoma

118
Q

Proximal, symmetric muscle weakness&raquo_space; distal
Upper extremity&raquo_space; Lower extremity
Progresses downward over weeks to months
Normal sensory exam and deep tendon reflexes

A

MG

119
Q

Epilepsy defined by

A

2 unprovoked seizures at least 24 hours apart

120
Q

Absence seizures medication

A

ethosuximide

121
Q

Tonic, atonic, myoclonic or generalized tonic-clonic medications

A

○ valproate, lamotrigine, topiramate

122
Q

Partial seizure medications

A

○ carbamazepine, lamotrigine

123
Q

Status Epilepticus

A

any type of prolonged seizure (>30mins) start treatment within 10 mins

124
Q

treatment for status epileptics- ongoing seizure

A

1st line :lorazepam, diazepam, usually try 3 doses
● 2nd line: fosphenytoin or phenytoin
○ if seizures continues x 20min then Phenobarbital
● 3rd line :midazolam drip, proposal, pentobarbital coma
● Treat fever electrolytes or withdrawal

125
Q

what is PANAS

A

Post-strep autoimmune neuropsychiatric disorder
● Clusters of patients who develop tics
○ Higher incidence of recent strep in new tics

126
Q

recovery plan for concussions

A

24 hr asymptomatic then return in increasing activity

127
Q

post concussion syndrome dx after symptoms last more than

A

3 months

128
Q

anti epileptic drug avoided in pregnancy

A

valproate acid should be AVOIDED because of higher trends noted of congenital malformations.

129
Q

cerebral palsy must to dx before what age?

A

3 (it is non-progressive)

130
Q

facts about cerebral palsy

A

brain lesions and #1 cause of child disability (premature babies)

131
Q

hypotonic–spasity —contractures and missed milestones

A

CP

132
Q

tx CP

A

botox, antidepressants, tendon release, parkinson’s drugs

133
Q

Locked-in-syndrome is classically caused by injury to which portion of the brain

A

bilateral brainstem. pt can still blink their eyes

134
Q

simple seizure is described as

A

focal neuro deficits with preserved consciousness

135
Q

complex seizure is described as

A

Confusion and bizarre behavior

136
Q

why is the vasodilator nimodipine given when a Subarachnoid hemorrhage is dx?

A

Clinically significant vasospasm complicates 20-30 percent of aneurysmal subarachnoid hemorrhage, and nimodipine has been shown to improve neurologic outcomes. Treatment is started within the first 4 days post-SAH and is continued for 21 days.

137
Q

diagnosis of Narcolepsy

A

Multiple sleep latency test

138
Q

An MRI with gadolinium contrast is the study of choice for suspected ________. Periventricular plaques is considered the classic finding for ______________

A

MS

139
Q

Complex seizures are most often found when the ____ lobe is affected.

A

temporal lobe

140
Q

most common skull fracture

A

linear

141
Q

Charcot-Marie-Tooth is an inherited demyelinating polyneuropathy most commonly seen during what period of life?

A

1st and 2nd

142
Q

the most important initial steps after establishing an IV and placing the patient on a monitor for altered mental status?

A

Blood glucose testing

143
Q

A 23 year old female present to the emergency room complaining of the ‘worst headache of her life’ for the past 3 hours. She tried ibuprofen without relief. She denies nausea or vomiting, and vision changes. A head CT reveals no apparent abnormalities. A lumbar puncture is performed and the CSF analyzed. Which of the following findings would confirm your suspected diagnosis?

A

must think subarchnoid hemorrhage with worst HA of life.

LP with show RBC (erythrocytes)

144
Q

A 34 year old male presents to the clinic complaining of feeling emotionally unstable, and having frequent headaches. He also states that he has noticed a resting tremor that improves with purposeful actions, and some stiffness or rigidity to his movement. These symptoms have gradually worsened over the last few months. Examination of the eyes is remarkable for dark rings that appear to encircle each iris. Which of the following tests, if abnormal, confirms this patient’s likely underlying condition?

A

parkinson like symptoms-in a young person, should prompt the dx of Wilson dz.
Serum ceruloplasmin, a copper binding protein, levels are typically reduced in these patients. If this test is positive, or you have a high clinical suspicion of the disease, a 24-hour urine copper test (with elevated levels) and a slit lamp exam for Kayser-Fleischer rings should also be performed. Kayser-Fleischer rings are the pathognomonic sign of Wilson’s Disease

145
Q

huntington’s dz presents between what ages

A

This condition is inherited in an autosomal dominant fashion, and symptoms usually begin to be manifest between the ages of 30-50

146
Q

Which of the following results is most helpful in diagnosing a Subarachnoid hemorrhage?

A

In SAH, the bleeding occurs into the space that is occupied by the CSF. Thus, RBC’s in the CSF is the most helpful of the options listed in making this diagnosis. ~95% of cases will show an abnormality on CT scan.

147
Q

jacksonian march is associated with which type of seizure?

A

‘Jacksonian March’ is due to discharges in the sensorimotor cortex causing rhythmic jerky movements that spread throughout the entire side of the body. This classic finding is most often associated with simple seizures.

148
Q

best imagining for CP

A

MRI is the preferred imaging test in diagnosing CP.

149
Q

bilaterally intranuclear ophthalmoplegia is associated with?

A

intranuclear ophthalmoplegia is paresis of the medial rectus muscle (slowness or loss of adduction) and when bilateral in nature, especially in a younger patient, is most likely caused by Multiple Sclerosis.

150
Q

What cluster of features make up Cushing’s Triad and indicate increased intracranial pressure?

A

Hypertension, bradycardia, respiratory depression

151
Q

58 year old male presents to the emergency department with a temperature of 103.1 F ( 39.5 C), a headache and has had persistent vomiting over the course of the last two hours, and his wife reports what sounds like seizure activity. He is currently showing signs of altered mental status, has a positive Kernig sign. What is the most appropriate next step in the management of this patient?

A

vancomycin plus ampicillin, plus cefotaxime. Dexamethasone may be added to improve meningeal penetration and decrease morbidity. CT head should then be pursued to determine presence or absence of space-occupying lesions, prior to the lumbar puncture.

152
Q

Which of the following is most effective as a primary monotherapy used to treat Partial seizures?

A

Carbamazepine is considered to be a first-line monotherapy drug effective in treating partial seizures with or without secondary generalization.

153
Q

What is the drug of choice in treating patients with Myasthenia Gravis?

A

Pyridostigmine

154
Q

Crescent shape tracking along brain is seen is what head bled?

A

subdural

155
Q

Patients suffering from Multiple Sclerosis tend to exhibit a variety of symptoms. Which of the following medications is used in the treatment of spasticity associated with this disease?

A

baclofen

156
Q

Which of the following is the most common artery involved in epidural hematoma?

A

The middle meningeal artery is involved in more than 75% of cases of epidural hematoma. Its course carries it over the lateral side of the head, and its superficial location predisposes it to injury.

157
Q

What is the diagnostic test of choice for bronchiectasis?

A

High resolution chest CT showing dilated tortuous airways is diagnostic of bronchiectasis.

158
Q

The CT scan reveals blood vessels leading to nodules within the lung, and he has a positive ANCA test, but otherwise labs are non-contributory.

A

Wegener’s Granulomatosis

159
Q

what is the workup for Diagnose new effusion in toxic-appearing patient
Suspected parapneumonic effusions (including patients with previously diagnosed effusions)

A

Thoracocentesis with analysis

160
Q

“ongoing or intermittent seizure activity without convulsions for at least 30 minutes, without recovery of consciousness between attacks.”

A

Non-convulsive status epilepticus

161
Q

is Flexion teardrop fracture an unstable cervical spine injury?

A

yes

162
Q

Trigeminal neuralgia, or tic douloureax, has been found to respond well to

A

carbamazepine.

PANCE review (19 decks)

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