Dit - Neuro Hyq And Quick Hits

Front 1

How do you diagnose West Nile Virus? What is the tx?

Back 1

Dx: Serology for IgM
Tx: supportive care

Front 2

What is the tx for the following types of headaches?
Tension:
Cluster:
Migrane:

Back 2

Tension: ketorolac (NSAID)
Cluster: 100% O2
Migrane: sumatriptan

Front 3

What agents can be used for the prophylaxis of migrane headaches?

Back 3

Verapamil (Ca-channel blocker)
Propanolol (Beta-Blocker)
Amitriptyline (TCA)
Naproxen (NSAID)
Valproic Acid (Anti-convulsant)

Front 4

Tx options for pseudotumor cerebri include weight loss, ___(drug)___, and the discontinuation of inciting agents such as ______,_____, and _____.

Back 4

Acetozolimide
inciting agents: Vit A, tetracycline, withdraw from steroids

Front 5

What is the pathology and where is the lesion?
1. Flaccid + spasic paralysis =
2. Impaired propioception + pupils do not react to light =
3. Bilateral loss of pain and temp below the lesion + hand weakness =
4. Bilaterall loss of vibration + spastic paralysis of legs then arms =
5. Bilateral loss of pain/temp and spastic paralysis below the lesion + bilateral flaccid paralysis at the level of the lesion

Back 5

1. ALS (CST + ant. horn)
2. Syphilis (DC)
3. Syringomyelia (damage to crossing fibers of CST and ant. horn cells)
4. B-12 deficiency (DC and CST)
5. Spinal artery stenosis (SPT, CST and ant. horn, but NOT DC)

Front 6

What are the characteristics of Brown-Sequard syndrome?

Back 6

Loss of DC, CST, SPT, and Ant. Horn all on one side --->

Ipsilateral loss of vib, touch, prop / Ipsilateral flaccid and spastic paralysis / Contralateral loss of pain and temp

Front 7

HYQ: Most likely cuase of a frontal HA in a 40-yo woman worse when bending over?

Back 7

Sinus

Front 8

HYQ: A 30-yo female has a severe HA in the left temporal region along with visions of flashing lights and nausea?

Back 8

Dx: migrane

if she was older, think temporal arteritis

Front 9

HYQ: What class of medications is the prefered tx for migranes?

Back 9

- Triptans (ex. sumatriptan)

Front 10

HYQ: What would be the preferred antihypertensive in a pt with chronic HTN and recurrent migranes?

Back 10

Beta Blocker

Arsenal: B-Blk, Ca-blk, TCA, NSAID, Anti-convulsants

Front 11

HYQ: what is the preferred TX for febrile seizures?

Back 11

Acetomenophen

Front 12

HYQ: a patient with a DVT develops a stroke. What study would most likely identify the underlying etiology of the stroke?

Back 12

Trans-esophageal echo to identify a patent foramen ovale

DVT's dont usually cuase stroke, they usually cause a PE-- unless there is a PFO

Front 13

HYQ: Lung cancer + muscle weakness -->

Back 13

Lambert-Eaton syndrome

Front 14

HYQ: A 66 yo woman with forgetfulness and decreased bilateral parietal lobe activity on PET scan -->

Back 14

Alzheimer's dz

Front 15

HYQ: What is the most sensitive test for MS?

Back 15

MRI of brain and spinal cord for multiple plaques.

Oligoclonal IgG bands in CSF is also Pathognomonic

Front 16

HYQ: what medication decreases the frequency of replases in patients with MS?

Back 16

INF-B

Front 17

HYQ: a 35-yo woman presents with ptosis and diplopia that worsens throughout the day--> what is the underlying problem?

Back 17

ACh-R antibodies at the NMJ = Myasthenia Gravis

Front 18

HYQ: what is the mechanism of action of the preferred medication in the tx of restless leg syndrome?

Back 18

DA agonisits

Front 19

HYQ: what test is used to confirm the MCC of syncope?

Back 19

MCC of syncope is vasovagal, order a tilt-table test

Front 20

What is the TX for benign essential tremmor?

Back 20

Beta-blockers. pts often self medicate with etoh

Front 21

What is the TX for Guillain-Barre syndrome?

Back 21

Plasmaphoresis and IVIG

Front 22

What medications are used in the TX of ALZ dementia?

Back 22

Cholinesterase inhibitors: Donepizil, Rivastigmine, Galantamine.

Mamantine is very helpful as a stand-alone drug

Front 23

HYQ: What is considered the most effective medication in the TX of trigeminal neuralgia?

Back 23

Carbamazepine

Front 24

HYQ: What medication should be given to the close contacts of those infected with either Meningococcal or HIB meningitis?

Back 24

Rifampin

Front 25

What is the TX for fungal meningitis?

Back 25

Amphoteracin B

Think AIDS pt, cryptococcal meningitis, India Ink stain, encapsulated organism

Front 26

What medications can cause seizures?

Back 26

Bupropion, Buspirone, Enflarune (E for Epilepsy), Theophylline overdose, B6 deficiency (d/t Isoniazid)

Front 27

HYQ: What is the TX for a subdural hematoma?

Back 27

Burr hole and surgical removal

Front 28

HYQ: MC predisposing condition for an intracranial hemorrhage?

Back 28

HTN

Front 29

HYQ: CT scan of the head shows a lunar shapped lesion --> what is the most likely cuase?

Back 29

Sub-dural hematoma cuased by tearing of the bridging veins d/t blunt trauma

Front 30

HYQ: what are the indications for carotid endarterectomy?

Back 30

70-99% occluded
50-69% occluded w/ sxs
80-99% occluded w/o sxs

Front 31

Petechiae can be seen in menigitis caused by ______, in a dz called _____. this is d/t _______. Treatment includes a 3rd generation cephalosporin (____) and ____ for close contacts

Back 31

N. Meningitidis, Waterhouse- Friedrichson syndrome, ceftriaxone, rifampin

Front 32

QH: ____ headaches are the MCC of HA

Back 32

Tension

Front 33

NS: any sudden onset of severe HA or focal neurologic deficits should be further examined using _________ to r/o hemorrhage

Back 33

CT w/o contrast

Front 34

QH: _________ is the MCC of THROMBOTIC ischemic stroke

Back 34

Atheroslerosis of carotid, basilar and vertebral arteries

Front 35

QH: The _______ artery is the MC artery involved in EMBOLIC ischemic stroke. Most emboli originate from the heart, aorta, carotid or intracranial arteries

Back 35

Middle Cerebral Artery

Front 36

QH:Berry aneurysms are assoc with _____ disease and _____ syndrome.

Back 36

Berry aneurysms are assoc with Adult Polycystic kidney dz and Marfan's syndrome

Front 37

QH: Pts may describe _____ as the "worst headache of my life"

Back 37

Subarachnoid hemorrhage

Front 38

QH: Pts with imminent rupture of berry aneursym may have ______ in the preceding weeks

Back 38

Multiple less severe sentinel headaches

Front 39

NS: if Sub Arachnoid Hemorrhage is suspected despite a negative CT, perform a_____

Back 39

Lumbar Puncture: RBCs, xanthochromia, increased pressure

Front 40

QH: the MCC of epidural hematoma is damage to the ______ from blunt trauma

Back 40

Middle Meningeal Artery

Note: Epidural is artery, subdural is vein

Front 41

NS: WIth mental status changes in an elderly pt with a hx of falls, perform a work-up for ____

Back 41

Subdural hematoma, do a CT scan

Front 42

NS: Do not perform an LP in pts with subdural hematoma b/c of increased risk of ______.

Back 42

Herniation.

Front 43

Mnemonic: The 3 W's of Normal Pressure Hydrocephalus

Back 43

Wet- Incotenance
Wacky - Cognitive impairment
Wobbly- Gait abnormality (short, low steps - magneto gait)

Front 44

The TX for status epilepticus is IV benzos, but if that pt has sizures d/t Eclampsia, use____

Back 44

Mag-sulfate

Front 45

QH: Clinical dx of ALS requires _____ in at least 2 extremities and _____ in one region

Back 45

ALS: LMN (flaccid paralysis, decreased DTRs, fassiculations) signs in at least 2 extremities, and UMN (spasticity, increased DTRs, + Babinski) in one region

Front 46

QH: Huntington's disease has ___% penetrance, but does not become symptomatic until ____.

Back 46

100% penetrance, onset is middle age (30-50)

Front 47

Mnemonic: C's of Huntington's disease

Back 47

Chorea
CAG
Chromosome Cuatro (4)
Caudate and Putamen
aCetylcholine decreas

Front 48

NS: The #1 cause of dementia ______ can be differentiated from the #2 cause of dementia______ with an MRI. Multiple small lesions/infarcts will be apparent on MRI when the cause is ______.

Back 48

#1 Alzheimers
#2 Multi-infact dementia -- cause is vascular

Front 49

Mnemonic: Remember that MS affects the _______ , and is more common in the MS than the MR.

Back 49

MS affects the Myelin Sheath in women around age 20. Get an MRI of the brain and spinal cord.

Front 50

QH: _______ is a paraneoplastic disorder (eg. small cell lung cancer) with similar presentation to MG. It occurs in smokers with weakness that improves with muscle use. The pathology is antibodies to presynaptic Ca-channels and is treated with immunosupressants and plasmaphoresis

Back 50

Lambert-Eaton syndrome - weakness improves with msucle uses

Myasthenia Gravis - weakness worsens throughout the day

Front 51

QH: ________Is a short acting anticholinesterase agent, making it ideal for MG testing.

Back 51

Edrophonium

Front 52

NS: if MG is diagnosed in a pt, perform a chest CT to look for _____

Back 52

a thymoma -- common in MG

Front 53

QH: _____ is the MC primary brain tumor in adults, while ____ is MC overall. ______ is the most common brain tumor in children

Back 53

MC overall = mets
MC adult = GBM
MC child = Astrocytoma

Front 54

QH: most mets to the brain are ____-tentorial

Back 54

Most mets to the brain are supratentorial

Front 55

NS: if an intracranial tumor is the initial lesion detected, workup should include a full search for ____

Back 55

search for the source of the neoplasm. Full body CT, blood cancer antigens, etc

Front 56

QH: Most of sleep is spent in stage __

Back 56

Most sleep is stage 2

Benzos increase stage 2 and decrease stage 3/4

Front 57

Patient in a coma:

Pupils large and non-reactive =
Pupils small and reactive =
Pupils pinpoint =

Back 57

Pupils large and non-reactive = damage below midbrain (CN-3 involvement) possible uncal herniation
Pupils small and reactive = Thalamic involvement, transtentorial herniation
Pupils pinpoint = Opioid overdose

Front 58

QH: ______ seizures the the MC sizure in children

Back 58

Febrile

Front 59

QH: _______ and _______ malformations are anatomic defects of the skull and ventricular system assoc with hydrocephalus in children

Back 59

Arnold-chiari type II and Dandy-walker

Front 60

QH: Spastic CP is caused by damage to the ______, where as Dyskinetic CP is cuased by damage to the ________

Back 60

Spastic CP = pyramidal tracts

Dyskinetic CP = extrapyramidal pathology

Front 61

The RB gene predisposes pts to both _______ and _______.

Back 61

RB gene for retinoblastoma and osteosarcoma

Front 62

QH: the MCC of conductive hearing loss is _____, the MCC of sensorineural hearing loss is _____.

Back 62

Otosclerosis is MCC of conductive, Presbycusis is MCC of sensorinural hearing loss