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555 Cards in this Set

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Q001. Parkinson's Disease - What is it; When does it start; Life expectancy
A001. ACh and dopamine must be in balance for normal, balanced movement; decreased levels of dopamine in substantia nigra; idiopathic hypokinetic; usually starts ~50-60 y/o; life expectancy ~ 9 yrs.
Q002. Parkinson's Disease - Insults that lead to; "parkinsonism"
A002. Most cases are idiopathic; insults decreased dopamine - postencephalitic; toxic insults - (carbon disulfide,,manganese, MPTP); bihemispheric ischemic; traumatic; iatrogenic (neuroleptic meds)
Q003. Parkinson's Disease - History/PE
A003. Tremor at rest (pill rolling); cogwheel rigidity; bradykinesia; festinating gait; stooped posture; unstable posture; masked faces; memory loss; micrographia; shy-dragger- any autonomic dysfunction
Q004. Parkinson's Disease - Tx
A004. 1st - is it from a secondary cause that can be reversed?; then - how does patient function daily?; tremor but functioning - > 60 y/o – amantidine; < 60 y/o - anticholinergic; if can't function - l-dopa-carbidopa, most effective but most side effects; "response fluctuations": Tx fluctuations - COMT or selegiline list of meds:; L-dopa/carbidopa - mainstay; bromocriptine; selegiline; entacapone (COMT inhib); amantadine & anticholinerg - limited efficacy; If meds fail & disease advanced - deep brain stimulation of GPi and subthal nucleus, or pallidotomy - ablation of GPi (posteroventral GP), rarely done now
Q005. Huntington's - What is it
A005. Hyperkinetic; AD; atrophy of caudate; lose GABA; CAG triple repeats on C4p; anticipation - progression expansion; > 39 repeats - mutant genes
Q006. Huntington's - History/PE
A006. Presents ~30-50 y/o; gradual onset of - chorea; dementia; altered behavior; depression
Q007. Huntington's - Dx
A007. Clinical; CT; MRI; molecular genetic testing
Q008. Huntington's - Tx
A008. No cure; disease cannot be halted; genetic counseling; haloperidol - psychosis; reserpine - minimize unwanted movements
Q009. Alzheimer's - What is it
A009. MCC of dementia in elderly; senile plaques - B amyloid; neurofibrillary tangles - abnorm phosphorylated tau protein; loss of ACh in cortex - basal nucleus of Meynert; amyloid angiopathy => lg lobar hemorrhage; hippocampus affected early
Q010. Alzheimer's - Risk factors
A010. Age - most important; family history; Down's (> 35 y/o); female gender; chromosomes 21, 14; chromosome 1 - younger age; chromosome 19 - older; homozygous for ApoE4 - high rate of Alzheimer's
Q011. Alzheimer's - History/PE
A011. Amnesia usually 1st sign; then language deficits; acalculia; depression; agitation; apraxia
Q012. Alzheimer's - Evaluation
A012. Dx of exclusion; definitive Dx only on autopsy; MRI or CT - diffuse cortical and subcortical atrophy; Neuropsych testing - distinguish between dementia and depression
Q013. Alzheimer's - Tx
A013. Supportive therapy; Cholinesterase inhibitors - first-line therapy; donepezil; rivastigmine; galantamine; Vit E (a-tocopherol) - may slow cognitive decline
Q014. Alzheimer's - Complications
A014. Survival is 5-10 yrs from onset of sxs; death usually secondary to aspiration pneumonia or other infections
Q015. Delirium - What is it caused by; Timing of onset; Course
A015. Caused by acute illness, infection or drug toxicity; Sudden onset; Reversible (usually); impairment of consciousness - decreased awareness of your environment; can't maintain attention
Q016. Dementia - What is it caused by; Timing of onset; Course
A016. Caused by anatomic changes in the brain; Slow, gradual onset; Irreversible
Q017. Subarachnoid Hemorrhage - What is it
A017. Due to bleeding from ruptured aneurysm; MCC - head trauma (Circle of Willis) (considered separate disorder); spontaneous ruptured aneurysm, usually congenital berry, associated with APKD, coarctation of aorta; other cause - AV malformation, ~50-60 y/o; high mortality
Q018. Subarachnoid Hemorrhage - History/PE
A018. Sudden-onset headache; "worst headache of my life"; loss of consciousness; fever; n/v; neck stiffness; seizure; CN3 palsy - if berry aneurysm; may be preceded by milder sentinel headaches, weeks earlier
Q019. Subarachnoid Hemorrhage - Dx
A019. CT without contrast immediately. blood appears white; if CT neg - LP immediately, check for xanthochromia; no LP if increased ICP - sudden decreased in CSF pressure can cause further bleeding; 4-vessel angiography to pinpoint location
Q020. Subarachnoid Hemorrhage - Tx
A020. Prevent 2nd rupture - most likely in 1st 48 hrs; obliterate aneurysm; IV fluids; keep BP OK; nimodipine -prevent vasospasm; phenytoin; lower ICP - raise head of bed, hyperventilation; pain meds - no NSAIDs; surgery - clip aneurysm; IR (stent-assisted) coiling
Q021. Subarachnoid Hemorrhage - Complications
A021. 2nd rupture - especially with aneurysm; extend into brain parenchyma- especially with AVM; arterial vasospasm; obstructive hydrocephalus
Q022. Epidural Hematoma - What is it
A022. Often due to blunt trauma; usually lateral skull fracture; tear of Middle Meningeal Art.
Q023. Epidural Hematoma - History/PE
A023. Lucid interval - min. to hrs. then headache; progressive obtundation; hemiparesis; "blown pupil"
Q024. Epidural Hematoma - Dx
A024. CT - lens-shaped convex hyperdensity; close observation and serial neuro exams before surgery
Q025. Epidural Hematoma - Tx
A025. Neurosurgical evacuation
Q026. Subdural Hematoma - What is it
A026. Usually after head trauma; rupture of bridging veins; cortex to dural sinuses; especially elderly & alcoholics
Q027. Subdural Hematoma - History/PE
A027. Headache; change in mental status - days to weeks; can present as dementia in elderly; contralateral hemiparesis; may have remote history of fall
Q028. Subdural Hematoma - Dx
A028. CT - crescent-shaped; concave hyperdensity
Q029. Subdural Hematoma - Tx
A029. Neurosurgical evacuation; blood may regress spontaneously if chronic; corticosteroids; phenytoin
Q030. Parenchymal Hemorrhage - Causes
A030. HTN (usually in basal ganglia); tumor; amyloid angiopathy - elderly; vascular malformations - AVM; cavernous hemangiomas
Q031. Parenchymal Hemorrhage - History/PE
A031. lethargy; headache; focal mtr & sensory deficits; some obtundation
Q032. Parenchymal Hemorrhage - Dx
A032. CT without contrast; check for mass effect or edema
Q033. Parenchymal Hemorrhage - Tx
A033. Raise head of bed; antiseizure prophylaxis; neurosurgical evacuation - if mass effect, especially in posterior fossa
Q034. Coma - What is Rule of 4
A034. 1. Thiamine, D50, naloxone, coma cocktail; 2. 2 mechanisms: bilateral hemisphere or RAS; 3. 3 general disease processes: structural, metabolism, seizures; 4. 4 key aspects to exam
Q035. Coma - General Processes: Structural
A035. Hematoma; Infarction; Abscess; Tumor; Abnormal imaging lesion that occupies space
Q036. Coma - General Processes: Metabolism
A036. Electrolyte, endocrine or metabolic functions; substrate deprivation - O2, glucose, vitamin deficiency; organ failure – kidney; toxins – meds, etoh, drugs; infections; inflammatory disease; Normal imaging
Q037. Coma - General Processes: Seizures
A037. Status epilepticus; postictal
Q038. Coma - 4 aspects of exam
A038. Pupils; eye movement; motor response; ventilation pattern - acid-base status
Q039. Coma - Tx
A039. Stabilize the patient; Airway; Breathing; Circulation; Reverse the reversible - coma cocktail; O2; ID and tx underlying cause; Prevent further damage
Q040. Broca's Aphasia - What is it; What part of brain affected
A040. Disorder of language production; motor; broken speech; comprehension is intact; expressive or nonfluent aphasia; posterior inferior frontal gyrus
Q041. Broca's Aphasia - Features
A041. Repetition is impaired; frustration - cuz aware; associated with - arm and face hemiparesis, hemisensory loss, apraxis of oral muscles; often secondary to left superior MCA stroke
Q042. Broca's Aphasia - Tx
A042. Speech therapy; tx underlying condition; wide range of outcomes; intermediate prognosis
Q043. Wernicke's Aphasia - What is it
A043. Disorder of language comprehension; nonsensical production; Wernicke's is wordy; left posterior superior temporal; receptive or fluent aphasia
Q044. Wernicke's Aphasia - Features
A044. Neologisms; word substitutions; unaware - no comprehension; secondary to left inferior/post MCA stroke
Q045. Wernicke's Aphasia - Tx
A045. Speech therapy; tx underlying condition; poorer prognosis than Broca's
Q046. Brain Neoplasms - Mets vs. Primary
A046. Benign usually > 65 y/o Metas - Lots of Bad Stuff Kills Glia: Lung Breast Skin Kidney GI; metas > primary; supratentorial; at junction of gray and white matter; MC primary in adults - glioblastoma and meningioma; most 1o are supratentorial; MC primary in kids - medulloblastoma & astrocytoma; most 1o are infratentorial
Q047. Brain Neoplasms - Dx
A047. CT with contrast; MRI with gadolinium; CT-guided Biopsy; Biopsy during surgical tumor debulking
Q048. Brain Neoplasms - General Principles of Tx
A048. Resection (if possible); radiation; chemo; palliative tx; corticosteroids - reduce vasogenic edema; type of therapy depends on - type of tumor, histology, progression, site
Q049. Brain Neoplasms:; Glioblastoma - Characteristics and; Presentation
A049. Grade IV astrocytoma; MC primary brain tumor; prognosis grave, < 1 year to live; can cross corpus callosum; progresses fast; headache; ICP
Q050. Brain Neoplasms:; Glioblastoma - Tx
A050. Surgical resection; radiation and chemo; have variable results
Q051. Brain Neoplasms:; Meningioma - Characteristics and; Presentation
A051. 2nd MC primary; often incites osteoblastic reaction in overlying cranial bones; originate from dura or arachnoid; good prognosis; incidence increased with age
Q052. Brain Neoplasms:; Meningioma - Tx
A052. Surgical resection; radiation for unresectable
Q053. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Characteristics and; Presentation
A053. Derived from schwann cells; bilateral schwannoma in NF2; Ipsilateral hearing loss; tinnitus; vertigo; signs of cerebellar dysfunction; facial weakness; facial sensory loss
Q054. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Tx
A054. Surgical removal
Q055. Brain Neoplasms:; Astrocytoma - Characteristics and; Presentation
A055. Grades 1 - pilocytic, mainly kids; grade 2 - diffuse; grade 3 - anaplastic; grade 4 - glioblastoma multiforme; headache; increased ICP; can cause unilateral paralysis in CN 5-7 & CN10
Q056. Brain Neoplasms:; Astrocytoma - Tx
A056. Resection if possible; radiation
Q057. Brain Neoplasms:; Medulloblastoma - Characteristics and; Presentation
A057. Highly malignant; arises from cerebellum and 4th ventricle; can compress 4th ventricle; may seed subarachnoid space; increased ICP; morning headaches
Q058. Brain Neoplasms:; Medulloblastoma - Tx
A058. Surgical resection; coupled with radiation and chemo
Q059. Brain Neoplasms:; Ependymoma - Characteristics and; Presentation
A059. Common in kids; arises from ventricles and spinal cord; commonly found in 4th ventricle; can cause hydrocephalus
Q060. Brain Neoplasms:; Ependymoma - Tx
A060. Surgical resection; radiation
Q061. Neurofibromatoses - What are they
A061. NF1 - von Recklinghausen, AD, chromosome 17; NF2 - chromosome 22
Q062. Neurofibromatoses - History/PE
A062. NF1 - 2 or more of: neurofibromas (2), cafe-au-lait spots (6), freckling - axillary or inguinal, optic Glioma, lisch nodules (2), osseous abnorm, 1st degree relative with NF1; NF2 - bilateral acoustic neuromas or 1st deg. relative with NF2 and unilateral acoustic neuroma or 1st deg. relative with NF2 and neurofibroma, meningioma, Glioma or schwannoma
Q063. Neurofibromatoses - Dx
A063. MRI – brain, brain stem, spine; derm exam; ophthal exam; family History; hearing test
Q064. Neurofibromatoses - Tx
A064. No cure; tx symptoms; surgical removal for; acoustic neuromas
Q065. Tuberous Sclerosis - What is it
A065. Seizures - start as infant; mental retardation; skin and eye lesions; small benign tumors – brain, face, eyes, kidney, other organs; very variable clinical course; AD; chromosome 9
Q066. Tuberous Sclerosis - History/PE
A066. Infantile spasms; ash-leaf lesions – hypopigmentation, trunk and extremities; shagreen patch - lumbosacral; sebac. adenoma - nose, cheeks; mulberry tumors; phakomas
Q067. Tuberous Sclerosis - Dx
A067. CT - calcified tubers, periventricular areas, can => astrocytomas (rare); Wood's UV lamp - skin lesions; EKG; renal US
Q068. Tuberous Sclerosis - Tx
A068. Clonazepam or valproic acid; increased ICP - may indicate a tuber obstructing Foramen of Munro, surgery
Q069. Von Hippel-Lindau - What is it
A069. AD; deletion of VHL gene on ch 3; hemangioblastoma – cerebellum, medulla; retinal angioma; RCC; pheochromocytoma
Q070. Von Hippel-Lindau - History/PE
A070. Headache; N/V; cerebellar Sxs; retinal angiomas - usually periphery, can => retinal detachment
Q071. Von Hippel-Lindau - Dx
A071. CT - head, abdomen; MRI - posterior fossa emphasis, serpentine signal voids; angiography - vascularity; CBC - polycythemia; VMA levels in urine; ophthal US
Q072. Von Hippel-Lindau - Tx
A072. Surgical resection; or radiation
Q073. Osler-Weber-Rendu - What is it
A073. AD; also called - Hereditary Hemorrhagic Telangiectasia (HHT); telangiectasia and AVM in lungs, GI, brain; recurrent epistaxis
Q074. Osler-Weber-Rendu - History/PE
A074. Recurrent epistaxis; painless bleeding in bowel; hepatic AV fistula - (hepatomegaly, RUQ pain, pulsatile mass, palpable thrill, audible bruit, high-output CHF, liver failure); hepatic encephalopathy - portosys shunt; neuro complications; rightt-to-left shunt - (cyanosis, clubbing, hypoxemia, secondary polycythemia, exertional dyspnea)
Q075. Osler-Weber-Rendu - Tx
A075. Iron; folate; symptomatic tx of epistaxis; ASA - contraindicated; embolization,; surgical excision or ligation of AV fistulas
Q076. Closed-Angle Glaucoma - What is it
A076. Med emergency; usu older patients and Asians; iris root plugs opening of trabecular meshwork; acutely pupillary dilation; anterior uveitis; dislocation of lens
Q077. Closed-Angle Glaucoma - History/PE
A077. Intraocular pressure increased very fast; extreme periocular pain; acute red eye; blurred vision
Q078. Closed-Angle Glaucoma - Dx; Tx
A078. Best diagnostic test - tonometry; Tx – acetazolamide, pilocarpine - when P drops; laser iridotomy - curative
Q079. Open-Angle Glaucoma - What is it
A079. Most common form; almost always bilateral; risk factors - > 40 y/o, Black, diabetic, myopic, family History; diseased trabecular meshwork obstructs proper drainage => intraoc P increased gradually; progressive vision loss; vision loss - moves periph to central => blindness
Q080. Open-Angle Glaucoma - History/PE
A080. Asymp initially; suspect if patient - > 35 y/o, freq. lens changes, mild headaches, vision disturbances, impaired adaptation to dark; earliest defect - periph nasal fields; cupping of optic disk
Q081. Open-Angle Glaucoma - Dx
A081. Tonometry; ophthalmic exam of optic nerve. central field testing; evaluate on long-term basis; can be hard to Dx until advanced stages
Q082. Open-Angle Glaucoma - Tx
A082. Prevention; > 40 y/o - exam every 3-5 yrs; with increased risk factor - annually; timolol, betaxolol; pilocarpine; acetazolamide; laser trabeculoplasty - if meds fail
Q083. Macular Degeneration - What is it
A083. MCC of permanent bilateral vision loss in elderly; vision loss – central, do not lose peripheral vision; atrophic - gradual loss; exudative – faster, damage more severe
Q084. Macular Degeneration - History/PE
A084. painless loss of central vision; atrophic - irreg pigmentation of macular region; exudative – hyperpigmentation, pimple-like elevation of macula - from hemorrhage
Q085. Macular Degeneration - Tx
A085. Laser photocoagulation - may delay loss of central vision in exudative
Q086. Retinal Artery Occlusion - What is it; History/PE
A086. From emboli or thrombi; sudden, painless, unilateral blindness; pupil accommodates but reacts sluggishly to direct light; cherry-red spot on fovea; artery may look bloodless; retinal edema
Q087. Retinal Artery Occlusion - Tx
A087. Thrombolysis within 8 hrs of onset of Sx; decreased intraoc P - drain anterior chamber; IV acetazolamide
Q088. Retinal Vein Occlusion - What is it; History/PE
A088. Sudden, painless; retinal hemorrhages; cotton wool spots; edema of fundus; elderly; MCC - HTN; can => macular disease, glaucoma
Q089. Retinal Vein Occlusion - Tx
A089. Laser photocoagulation
Q090. Increased ICP - Causes
A090. Blood - EDH, SDH, SAH, ICH; spontaneous or traumatic; CSF - hydrocephalus; idiopathic intracranial HTN; brain mass - tumor; trauma -cerebral contusions; edema – trauma, tumors
Q091. Increased ICP - Signs in approx. order; of appearance
A091. N/V and headache; altered mental status; in kids - bulging fontanelles; papilledema; CN palsies - especially CN6; Cushing's Triad - (HTN, bradycardia, irregular breathing); end-stage - cerebral herniation
Q092. Increased ICP - Tx - in order
A092. Make sure BP and respiratory good; sedation; elevate head of bed; IV mannitol; hyperventilate to CO2 30-35; ventriculostomy; surgery - removal of hematoma, decompressive craniectomy
Q093. Herniation - What is it; Types; Dx
A093. Endpoint of untreated masses or increased ICP; specific signs and Sxs depends on type of hernia and mass lesion; uncal herniation - CN3 compression: ipsilat dilated pupil; midbrain compression: ipsilat hemiplegia; tonsillar herniation - respiration compromise; Dx - CT without contrast - rule out mass lesion or hemorrhage
Q094. Guillain-Barre - What is it
A094. Acute, rapidly progressive, acquired demyelinating autoimmune disorder of periph nerves; recent C. jejuni infection; viral infection; recent vaccination
Q095. Guillain-Barre - History/PE
A095. Rapidly progressive; ascending paralysis; involves trunk, diaph and CN; autonomic Sxs; areflexia
Q096. Guillain-Barre - Dx
A096. Diffuse demyelination on - EMG & nerve conduction studies; albuminocytologic dissociation; CSF protein > 55 mg/dL
Q097. Guillain-Barre - Tx
A097. ICU - risk of respiratory failure; plasmapheresis or IVIG; aggressive rehab
Q098. MS - What is it
A098. Acquired demyelinating disease; may have T cell-mediated autoimmune pathogenesis; environmental and genetic; female-to-male 2:1; 20-40 y/o; increased prevalence with greater distance from equator; risk - related to where lived the 1st 15 yrs. of life; subtypes – benign, relapsing/remitting, 2o progressive, chronic progressive
Q099. MS - History/PE
A099. Multiple neuro complaints in time and space, can't be explained by a single lesion; limb weakness; optic neuritis; paresthesias; diplopia; internuclear ophthalmoplegia; urinary retention; vertigo; Sxs wax & wane or progress; exacerbations – stress, infections, heat, trauma, vigorous activity
Q100. MS - Dx
A100. Multiple, asymmetric periventricular lesions in white matter; corpus callosum lesions - pathognomonic; active lesions enhance with Gado on MRI; increased CSF IgG, oligoclonal bands
Q101. MS - Tx
A101. Acute - steroids treat Sxs:; spasticity: baclofen or zanaflex; pain: phenytoin; fatigue: amantadine or provigil; avoid hot climates; prophylaxis: immunomodulators, reduce number of attacks, disability; Avonex - once weekly IM; Betaseron- every other day subq; Copaxone - daily subq
Q102. Stroke - Types
A102. Ischemic - 80%; emboli; thrombi; systemic hypoperfusion; hemorrhagic
Q103. Stroke - Risk Factors
A103. Age; male; race; HTN; diabetes; obesity; smoking; hypercholesterolemia; AF; carotid stenosis; coke; alcohol; IV drug user
Q104. Stoke - History/PE; MCA
A104. Aphasia; neglect; gaze preference; homonymous hemianopsia; contralateral hemiparesis - arm/face > leg
Q105. Stoke - History/PE; ACA
A105. Amnesia; personality changes; foot drop; gait dysfunction; cognitive changes; contralateral hemiparesis - leg > arm/face
Q106. Stoke - History/PE; PCA
A106. Homonymous hemianopia; memory deficits; dyslexia/alexia
Q107. Stoke - History/PE; Basilar
A107. Coma; CN palsies; apnea; visual Sxs; drop attacks; dysphagia
Q108. Stoke - History/PE; Lacunar
A108. Unilateral pure motor or sensory; dysarthria - clumsy hand syndrome; ataxic hemiparesis
Q109. Stoke - History/PE; TIA
A109. Transient neuro deficits; last < 24 hours; most last < 1 hour
Q110. Stoke - Dx
A110. CT without contrast - ischemic vs. hemorrhagic; MRI; EKG; echocardiogram; vascular studies - carotid US; MRA; transcranial doppler or MRA; screen for hypercoagulability; PE
Q111. Stoke - Tx; Preventive and Long-Term
A111. Vigilance for signs of - brain swelling: increased ICP, herniation; tPA - ischemic stroke if admin within 3 hrs. of onset of Sxs; ASA - ischemic stroke presenting within 48 hours; no hypotension, hypoxemia, hypoglycemia; tx aspiration pneumonia, UTI or DVT; Preventive & long-term Tx - * ASA, clopidogrel or dipyridamole/ASA; carotid endarterectomy; anticoags; management of HTN, DM and hypercholesterolemia
Q112. Carpal Tunnel Syndrome - What is it; Risk factors
A112. Median nerve compression where; passes thru carpal tunnel; women 30-55; Risk factors - repetitive use injury; pregnancy; DM; hypothyroidism; acromegaly; RA; obesity
Q113. Carpal Tunnel Syndrome - History/PE
A113. Wrist pain; numbness & tingling of 3 1/2; weak grip; decreased thumb opposition; thenar atrophy; nocturnal pain & paresthesias; Sxs may awaken patient at night; relieved by shaking wrist
Q114. Carpal Tunnel Syndrome - Workup
A114. Tinel's sign – tap, tingle; Phalen's sign - ph-lex (flex), paresthesias; EMG - to confirm; NCV - to confirm; evaluate for risk factors
Q115. Carpal Tunnel Syndrome - Tx
A115. Neutral wrist splint; modify activity; create ergonomic work environment; NSAIDs; corticosteroids - direct injection; surgery if Sxs persist - carpal tunnel release
Q116. Myasthenia Gravis - What is it
A116. Autoimmune: Ab that bind to postsynaptic Ach receptors (nicotinic); block receptors; lose receptors; young adult women; can be associated with – thymoma, thyrotoxicosis
Q117. Myasthenia Gravis - History/PE
A117. Muscle weakness increased in periods of activity; decreased after rest; Sx come and go; onset can be sudden; fluctuating fatigable ptosis; diplopia (double vision); dysphagia (swallowing); dysarthria (speech); Sxs worsen throughout day; myasthenic crisis - so severe, respiratory failure and aspiration, secondary to weakness, often secondary to infection (respiratory muscles compromised); ocular myasthenia - common variant, if doesn't spread in 2-3 yrs, probably won't
Q118. Myasthenia Gravis - Dx
A118. Edrophonium (tensilon test) - diagnostic; abnormal single-fiber EMG: decreased response to repetitive nerve stimulation; antistriatal ab if thymoma; chest CT - evaluate for thymoma
Q119. Myasthenia Gravis - Tx
A119. Neostigmine (treat Sx); pyridostigmine (treat Sx); prednisone; plasmapheresis or IVIG - temp relief (wks) if severe; thymoma resection
Q120. Amyotrophic Lat. Sclerosis - What is it
A120. Progressive neurodegenerative disease; unknown etiology; degeneration of motor neurons; UMN and LMN degenerate => respiratory failure and death
Q121. Amyotrophic Lat. Sclerosis - History/PE
A121. Slowly progressive weakness; may have fasciculations initially; UMN and LMN
Q122. Amyotrophic Lat. Sclerosis - Dx
A122. Clinical presentation; EMG and nerve conduction studies; CT/MRI - cervical spine, check for lesions; rule out systemic causes - CBC TSH SPEP UPEP; Ca2+ PTH PFTs; urine for heavy metal - (if history of exposure)
Q123. Amyotrophic Lat. Sclerosis - Tx
A123. Supportive; patient education; pulmonary specialist; riluzole
Q124. Thiamine (B1) Deficiency - What are Signs/Sxs
A124. Wernicke's: inadeq intake or absorption; excessive alcohol interferes with GI absorption and liver storage; acute onset – confusion, opthalmoplegia – nystagmus, lateral rectus palsy, conjugate gaze palsy, abnormal pupils, ataxia - vestibular dysfunction, cerebellar dysfunction
Q125. Thiamine (B1) Deficiency - Patients
A125. Alcoholics; dialysis; hyperemesis; starvation; cancer; AIDS; can be triggered by large-dose glucose admin if deficient
Q126. Thiamine (B1) Deficiency - Tx
A126. Reversible almost immediately with thiamine admin
Q127. Korsakoff's Psychosis - What is it
A127. Late complication of untreated patients with Wernicke's; can be triggered by severe or repeated DTs; can be triggered by SAH and thalamic injuries; immediate memory affected; confabulation
Q128. Korsakoff's Psychosis - Tx
A128. Prognosis good - head injury and SAH; irreversible - others
Q129. B12 deficiency - What are Signs/Sxs
A129. Subacute combined degeneration
Q130. B12 deficiency - Patients
A130. Patients with pernicious anemia
Q131. B12 deficiency - Tx
A131. B12 injections or large oral doses
Q132. Folate Deficiency - What are Signs/Sxs
A132. Irritability; glossitis; diarrhea; depression; neural tube defects
Q133. Folate Deficiency - Patients
A133. Alcoholics – alcohol interferes with absorption; Patients with pernicious anemia
Q134. Folate Deficiency - Tx
A134. Reversible if corrected early
Q135. Seizures - General Evaluation
A135. Epilepsy - seizure disorder, 2+ seizures not related to reversible stressors; was seizure epileptic – History, increased prolactin = epileptic VITAMINS - seizure caused by; vascular; infection; trauma; autoimmune; metabolic; idiopathic; neoplasm; sychiatric (faking it); 1st seizure not treated when underlying cause unknown
Q136. Partial Seizures - What are they
A136. Arise from focus; limited to one side; consciousness usually not lost; simple partial & complex part; can progress to generalized
Q137. Partial Seizures - History/PE
A137. Simple partial - consciousness not impaired; motor - Jacksonian march; sensory - parietal; autonomic - BP, HR, PVR; psychic - fear, deja vu; postictally - Todd's paralysis; resolves in 1-2 days Complex partial - consciousness impaired; temporal lobe: auditory or visual hallucination, déjà vu, automatisms; postictal – confusion, amnesia
Q138. Partial Seizures - Workup
A138. EEG; rule out systemic causes – CBC, electrolytes, Ca2+, fasting glucose, LFTs, tox screen, RPR, renal panel, ESR; rule out mass - MRI or CT with contrast
Q139. Partial Seizures - Tx
A139. Tx underlying cause; recurrent partial – phenytoin, oxcarbazepine, tegretol, phenobarbital, valproic acid; kids - phenobarbital; intractable temporal lobe - WADA testing, anterior temporal lobectomy
Q140. Generalized Seizures - What are they
A140. Begin diffusely throughout both sides; consciousness always lost; postictal confusion; most common types - tonic-clonic (grand mal), absence (petit mal)
Q141. Tonic-Clonic Seizures - History/PE
A141. Start suddenly with tonic extension of back and extremities; repetitive symmetric clonic movements; incontinence; tongue biting; may look cyanotic; consciousness slowly regained; may complain of - muscle ache, headache
Q142. Tonic-Clonic Seizures - Tx
A142. Tx underlying cause; idiopathic - valproate - 1st line; lamotrigine - adjunctive; topiramate - adjunctive; symptomatic - same therapy as partial seizure.
Q143. Absence (Petit Mal) Seizures-; What are they
A143. Begin in childhood; subside before adulthood; often familial
Q144. Absence (Petit Mal) Seizures-; History/PE
A144. Brief, often unnoticeable episodes of impaired consciousness; lasts 5-10 seconds; have 100's of times/day; amnestic during and immediately after eye flutters or lips smack; can be precipitated by hyperventilation
Q145. Absence (Petit Mal) Seizures-; Evaluation
A145. EEG - 3 Hz per sec. spike & wave discharges
Q146. Absence (Petit Mal) Seizures-; Tx
A146. Ethosuximide - 1st line; valproic acid; zonisamide
Q147. Infantile Spasms; (West Syndrome) - What is it; Tx
A147. Syndrome - infantile spasms (generalized seizures); symmetric, tonic, 5-10 at a time while drowsy or upon awakening; abnormal interictal EEG; arrest of psychomotor development at age of onset; starts at 3-12 months; usually male; MR; Tx – ACTH, prednisone, clonazepam, valproic acid
Q148. Status Epilepticus - What is it; Common Causes
A148. Brain in persistent state of Seizure; consistent seizure or recurrent without regaining consciousness > 30 min. med emergency - 20% mortality; common causes - anticonvulsive withdrawal/noncompliance, anoxic brain injury, alcohol withdrawal, metabolic disturbance (hypoNa+), trauma, infection; usual cause - subtherapeutic or noncompliance
Q149. Status Epilepticus - Evaluation
A149. Airway, breathing, circulation; labs – electrolytes, anticonvulsants; get History; look for etiology if no prior History (tumor, encephalitis, SAH); (EEG, CT only when stable)
Q150. Status Epilepticus - Tx
A150. Diazepam or lorazepam; if continues - phenytoin or fosphenytoin; if continues - phenobarbital; if continues - midazalom or propoful
Q151. Headache - Things to think about; (Evaluation)
A151. Headache new or old; characteristics; any associated Sxs; any neurological Sxs; SAH suspected?
Q152. Migraine Headache - What is it
A152. More commonly affects women and those with family History; vascular & 5HT abnorm; triggers – menses, OCP, chocolate, fasting, stress, bright lights
Q153. Migraine Headache - History/PE
A153. Throbbing > 2 hrs, usually lasts < 24 hrs; n/v; photophobia; sensitive to noise; "classic" migraine - visual aura precedes, unilat; "common" migraine - 80%, can be bilateral, periorbital
Q154. Migraine Headache - Dx
A154. History; if have focal neuro deficits - CT or MRI; Sxs acute in onset - rule out meningitis or SAH
Q155. Migraine Headache - Tx
A155. Avoid known triggers; aspirin/NSAIDs; sumatriptan; prophylaxis - beta-blockers, TCAs, Ca2+ channel blockers, valproic acid
Q156. Cluster Headache - What is it
A156. Men, ~ 25 y/o - age of onset
Q157. Cluster Headache - History/PE
A157. Unilateral, periorbital; 30 min. - 3 hrs. attacks in clusters - same part of head, same time of day, same time of year; can be precipitated by alcohol or vasodilators; ipsilateral tearing of eye
Q158. Cluster Headache - Dx
A158. History
Q159. Cluster Headache - Tx
A159. Acute therapy with high-flow O2 (100% nonrebreather O2); sumatriptan; corticosteroids; prophylaxis - Ca2+ channel blockers, valproic acid, methylsergide; prophylaxis important - by the time abortive meds take effect, has already resolved; methylsergine (sansert) - need drug holiday every several months to avoid risk of retroperitoneal fibrosis
Q160. Tension Headache - What is it
A160. MC type diagnosed in adults; chronic
Q161. Tension Headache - History/PE
A161. Tight, bandlike pain; occipital and neck; exacerbated by – noise, bright lights, stress, fatigue
Q162. Tension Headache - Dx
A162. Dx of exclusion
Q163. Tension Headache - Tx
A163. Avoid exacerbating factors; NSAIDs - 1st line; prophylaxis - Ca2+ channel blockers; alpha blockers; TCAs
Q164. Benign Paroxysmal; Positional Vertigo - What is it
A164. Peripheral vertigo; otoliths dislodge from usual position; migrate over time into semicircular canals; abnorm fluid displacement => vertigo
Q165. Benign Paroxysmal; Positional Vertigo - History/PE
A165. Sudden onset of severe vertigo and nystagmus; vertigo with head movement in direction of affected ear; happens turning head in bed; 5 sec. - 1 min. n/v; Sxs decreased with repetitive tests; usually history of recent trauma
Q166. Benign Paroxysmal; Positional Vertigo - Dx
A166. Nylen-Barany Maneuver; (Dix-Hallpike)
Q167. Benign Paroxysmal; Positional Vertigo - Tx
A167. Usually subsides spontaneously in weeks to months; Epley Repositioning Maneuver
Q168. Meniere's Disease; (Endolymphatic Hydrops) - What is it
A168. Peripheral vertigo from buildup of endolymphatic fluid in inner ear = V and P change; risk factors - head trauma, syphilis
Q169. Meniere's Disease; (Endolymphatic Hydrops) - History/PE
A169. Sudden attacks of vertigo; lasts up to 24 hours; attacks can last hours to days; n/v; ear fullness; tinnitus; hearing loss; significant permanent hearing loss; can occur over period of years
Q170. Meniere's Disease; (Endolymphatic Hydrops) - Dx
A170. Audiometry - low-freq. pure tone hearing loss
Q171. Meniere's Disease; (Endolymphatic Hydrops) - Tx
A171. Low-salt diet; acetazolamide; acute – antihistamines, antiemetics, benzos; if refractory - surgical decompression
Q172. Deep Fibular Nerve
A172. FOOT DROP, paresthesia in webspace between big toe and second toe
Q173. Femoral Nerve
A173. (from posterior division of L2, L3, L4); longest branch is saphenous nerve - sensation over area of great saphenous vein;; impaired ability to flex at hip and extend knee;; decreased patellar reflex
Q174. Superior Gluteal Nerve
A174. (L4, L5, S1 - exits via greater sciatic foramen above piriformis); innervates gluteus medius, minimus and tensor fascia latae;; impaired hip abduction,; in walking - "Trendlenburg" gait: pelvic tilt (sag) toward opposite side form lesion
Q175. Inferior Gluteal Nerve
A175. (L5-S2; gluteus maximus - exits greater sciatic foramen below piriformis w/ pudendal and sciatic); impaired lateral rotation and extension of thigh at hip, DIFFICULTY GETTING UP FROM A CHAIR, gluteus minimus gait = thrust torso posteriorly
Q176. Superficial Fibular Nerve
A176. impaired eversion and dorsal sensation, but extension is intact
Q177. Tibial Nerve
A177. "tarsal tunnel syndrome"; decreased flexion of big toe, difficulty standing on tiptoe
Q178. Obdurator Nerve
A178. (L2-4, anterior division, medial thigh-adductors- exits via obdurator canal); impaired adduction of thigh at hips
Q179. Terrible triad
A179. anterior cruciate ligament; medial collateral ligament; medial meniscus
Q180. Anterior drawer sign
A180. tibia displaced anteriorly to femur in flexed knee; indicated ACL tear
Q181. Sx of torn Medial collateral ligament
A181. pain when leg is rotated medially at the knee; (abnormal passive abduction)
Q182. Foot drop (loss of dorsiflexion)
A182. tibialis anterior; Common peroneal nerve (L4-S2); (PED: Peroneal Everts and Dorsiflexes)
Q183. Loss of plantar flexion
A183. gastroc and soleus; Tibial N (L4-S3); TIP: Tibial Inverts and Plantarflexes (if injured, can't stand on TIPtoes)
Q184. Loss of knee jerk
A184. Femoral Nerve; L2,3,4
Q185. Loss of hip adduction
A185. Obdurator (L2,3,4)
Q186. Vertebral disk herniation usu occurs between which vertebrae?
A186. between L5 and S1; Sciatica!
Q187. Lumbar puncture pierces which structures?
A187. SLEDsA to CSF; Skin/superficial fascia; Ligaments (supraspinous, interspinous and ligmentum flavum if puncture is off midline); Epidural space and intralaminal space; Dura mater; subdural potential space; Arachnoid; CSF is in the subarachnoid space
Q188. Which nerve extends the knee?
A188. femoral
Q189. Which nerve flexes the knee?
A189. Tibial
Q190. Nerves that contain fibers from the superior rami of the plexus (L2-L4) innervate muscles in the
A190. anterior compartment; (that act at the hip and knee joint).
Q191. Nerves that contain fibers from the inferior rami of the plexus (S1-S3) innervate muscles of
A191. the leg (that act on ankle and foot joints)
Q192. Dermatome paresthesia at the anterior thigh
A192. L3
Q193. Dermatone paresthesia at the medial leg
A193. L4
Q194. Dermatome paresthesia at the anterior leg and dorsum of foot
A194. L5
Q195. Dermatome paresthesia at the lateral foot and sole
A195. S1
Q196. Patellar tendon reflex
A196. L4
Q197. Achilles tendon reflex
A197. S1
Q198. Obturator nerve comes from
A198. L2-L4 (anterior division)
Q199. Femoral
A199. L2-L4 (posterior division)
Q200. Common Fibular comes from roots
A200. L4 L5 S1 S2 (posterior division)
Q201. Tibial nerve comes from roots
A201. L4 L5 S1-S3 (anterior division)
Q202. Motor weakness with obturator lesion
A202. adduction of thigh; (affected hip flexors and hip adductors)
Q203. motor weakness with femoral lesion
A203. extension of knee
Q204. motor weakness with common fibular lesion
A204. foot drop; (dorsiflexion, foot eversion)
Q205. motor weakness with tibial lesion
A205. no plantar flexion or toe flexion
Q206. Pregnancy can cause compression of
A206. L3/obturator
Q207. Psoas abscess can cause a lesion of
A207. Femoral
Q208. Common (4) injuries to the Common Fibular nerve
A208. 1) compression at fibula neck; 2) hip fracture or dislocation; 3) misplaced gluteal injection; 4) piriformis syndrome
Q209. Penetrating trauma to buttock or hip fracture/dislocation can cause nerve damage to
A209. Common fibular or tibial
Q210. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
A210. stroke
Q211. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
A211. cerebral infarct or ischemic stroke
Q212. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
A212. HEMORRHAGIC STROKE
Q213. cause of ischemic stroke
A213. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
Q214. type of hemmorage?; site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
A214. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
Q215. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
A215. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
Q216. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
A216. SUBARACHNOID HEMORRHAGES (SAH)
Q217. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
A217. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
Q218. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis
A218. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
Q219. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
A219. ACUTE EFFECTS OF SEVERE HYPERTENSION
Q220. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
A220. subdural hematoma
Q221. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
A221. epidural hematoma
Q222. type of Blunt Head injury?; clinical features: TRANSIENT LOC (level of conciousnes); characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY/damage = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
A222. CONCUSSION
Q223. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
A223. CONTUSION
Q224. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
A224. stroke
Q225. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
A225. cerebral infarct or ischemic stroke
Q226. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
A226. HEMORRHAGIC STROKE
Q227. cause of ischemic stroke
A227. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
Q228. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
A228. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
Q229. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
A229. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
Q230. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
A230. SUBARACHNOID HEMORRHAGES (SAH)
Q231. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
A231. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
Q232. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis
A232. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
Q233. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
A233. stroke
Q234. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
A234. ACUTE EFFECTS OF SEVERE HYPERTENSION
Q235. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
A235. cerebral infarct or ischemic stroke
Q236. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
A236. subdural hematoma
Q237. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
A237. HEMORRHAGIC STROKE
Q238. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
A238. epidural hematoma
Q239. cause of ischemic stroke
A239. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
Q240. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
A240. CONCUSSION
Q241. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
A241. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
Q242. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
A242. CONTUSION
Q243. type of hemorrhage?; Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
A243. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
Q244. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID
A244. LACERATION
Q245. type of hemorrhage?; site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
A245. SUBARACHNOID HEMORRHAGES (SAH)
Q246. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
A246. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
Q247. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolosclerosis
A247. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
Q248. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
A248. ACUTE EFFECTS OF SEVERE HYPERTENSION
Q249. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
A249. subdural hematoma
Q250. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
A250. epidural hematoma
Q251. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
A251. CONCUSSION
Q252. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
A252. CONTUSION
Q253. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID
A253. LACERATION
Q254. type of blunt head injury?; clinical feature: PROLONGED LOC; characteristic: TEARING OF AXONS (SPHEROIDS) IN CORPUS; CALLOSUM, LONG TRACTS
A254. Diffuse axonal damage
Q255. PENETRATION OF BRAIN OR SPINAL CORD BY PROJECTILE OR OTHER MOVING OBJECT; (bullet, knife blade, etc.); AMOUNT OF DAMAGE DEPENDS ON MASS, SHAPE, AND VELOCITY OF MISSILE
A255. MISSILE HEAD INJURY
Q256. type of MISSILE HEAD INJURY?; missile produces depressed fracture but does not enter skull
A256. DEPRESSED
Q257. type of MISSILE HEAD INJURY?; missile enters cranial cavity
A257. PENETRATING
Q258. type of MISSILE HEAD INJURY?; missile enters and exits cranial cavity
A258. PERFORATING
Q259. type of stroke?; obstruction of a feeding blood vessel or a significant reduction in blood flow
A259. Ischemic
Q260. type of stroke?; rupture of a blood vessel into or around the brain
A260. Hemorrhagic
Q261. 8 signs and symptoms of stroke
A261. Sudden onset (usually maximum within 10 seconds); Weakness of one side of the body / face; Numbness / tingling of one side of the body or face; Incoordination / clumsiness of one side of the body, falling to one side, spinning sensation; Sudden change in speech or language; Loss of vision, especially in one eye on or one side, Double vision; Acute confusion; Sudden, severe headache
Q262. acute stroke management
A262. Evaluation and stabilization of patient: Vitals, cardiovascular, neurological assessment, O2 NC, HLIV x2; Diagnostic work-up begun: Labs, brain imaging (CT, MRI); Consider “clot-buster”: t-PA therapy (call Stroke Team); **must tx pt with in 60 min arrive
Q263. focused stroke history, 11 risk factors
A263. High blood pressure (hypertension); "High sugar" (diabetes); Heart disease, heart attacks, irregular heart beats; High cholesterol; Smoking, alcohol use, illegal drugs; No regular physical exercise; Family history of stroke; Previous stroke; Sickle-cell disease
Q264. 5 focal symptoms for focused stroke history
A264. Change or loss of vision (one eye? both eyes?); Numbness, tingling, weakness, clumsiness, heaviness of one side of the body; Change or loss of language (understanding, comprehension, reading, writing); Change or loss of steady walking, imbalance, falling; Headache (location, type, severity, duration)
Q265. focused neurological findings in focused stroke history and physical
A265. Level of consciousness (alert, lethargic / drowsy, stupor, coma); Language (comprehension, fluency, repetition, naming, reading, writing); Visual fields and eye movements (other CN); Strength (face, arms, legs, drift) and reflexes; Coordination (gait, finger to nose, heel to shin); Sensation (pinprick, temperature, joint position sense / vibration)
Q266. t-PA criteria
A266. Inclusion criteria: Age ≥ 18, Ischemic stroke with measurable deficit, < 3 hr since symptom onset (time of onset is critical); Clock starts when patient last seen normal; Many exclusions, but patients meeting the above criteria should be considered for thrombolytic treatment
Q267. These are complications for what neurologic condition?; Seizures; Cardiovascular (MI, arrhythmia, sudden death); Respiratory (aspiration pneumonia, DVT / PE); Endocrine (hyperglycemia, hyponatremia); Urinary tract infection; Decubitus ulcers; Psychological / Psychiatric; Depression (40%); Confusion / combativeness / hallucinations; Abulia
A267. stroke
Q268. Carotid Endarterectomy
A268. Symptomatic: NNT = 6; Asymptomatic: NNT = 100; 90% > 80% > 70% > 60% stenosis; Benefit regardless of age, but older > younger; Ulcerated plaque; Hemispheric TIA / stroke (vs. retinal); Men> women; Associated stroke risk factors: Hypertension, diabetes, tobacco, lipids
Q269. Carotid Angioplasty and Stenting
A269. Increasingly used, with only one RCT showing efficacy / equivalence to CEA (3 stopped early); Multiple trials underway (carotid disease); FDA approved only for high-risk patients with symptomatic high-grade stenosis; With few exceptions, vertebrobasilar and intracranial stenting should be limited to RCTs; As with CEA, ask about complication rates
Q270. neurocutaneous disorder?; def: autosomal dominant disorder caused by; TSC gene mutation (chromosome 9: TSC1, hamartin;; chromosome 16: TSC2, tuberin); INCIDENCE: 1 in 29,000 births; CLINICAL FEATURES: Seizures/infantile spasms, Mental retardation, Behavioral abnormalities, Neoplastic and non- neoplastic tumors (cerebral tubers, retinal tumors, cardiac rhabdomyomas, renal tumors), Cutaneous lesions (ash leaf spots, facial angiofibromas, etc.)
A270. tuberous sclerosis
Q271. neurocutaneous syndrome?; Facial angiomas involving V1 and rarely V2 /V3 distribution. Underlying venous pial angiomatosis causing seizures, hemiparesis hemianopsia, mental deterioration.
A271. Sturge Weber Syndrome
Q272. areas that are sensitive to hypoxic ischemic encephalopathy in a term infant
A272. parasagittal, ulegyria (selective loss of cortex in depth of sulci), thalamus, BG and brainstem
Q273. where are the following tumors located and what age group are they associated with?; astrocytomas / glioblatomas; metastatic carcinomas; menigiomas; lymphomas; pituitary adenomas
A273. location: cerebrum; age group : adults
Q274. where are the following tumors located and what age group are they associated with?; metastaic carcinomas; menigiomas; schwannomas (cn VIII)
A274. location: posterior fosssa; age group: adults
Q275. where are the following tumors located and what age group are they associated with?; PNET; ependymonas; choroid plexus tumors; optic nerve gliomas; germ cell tumors; craniopharyngiomas
A275. location: cerebrum; age group: children
Q276. where are the following tumors located and what age group are they associated with?; PNET (cerebellar medulloblastoma); pilocytic astrocytomas; ependymomas; brainstem gliomas
A276. location: posterior fossa; age group: children
Q277. type of brain tumor?; A SLOWLY GROWING NEOPLASM OF ASTROCYTES TYPICALLY ARISING IN THE CEREBELLUM OF CHILDREN
A277. pilocytic astrocytoma, who grade 1
Q278. what are the locations for pilocytic astrocytoma, who grade 1 in children?
A278. cerebellum, optic nerve,; hypothalamus
Q279. what are the locations for pilocytic astrocytoma, who grade 1 in adults?
A279. adults: less common but usually occur in; cerebrum, spinal cord
Q280. what brain tumor has the following features?; mostly solid growth pattern, often cystic; slowly growing; indolent clinical behavior; do not progress in grade over time
A280. pilocytic astrocytoma, grade 1
Q281. tumor composed of cells resembling oligodendrocytes
A281. OLIGODENDROGLIOMA, GRADE 2
Q282. location of OLIGODENDROGLIOMA, WHO GRADE 2
A282. cerebral hemispheres
Q283. what brain tumor has the following features?; often slow-growing; infiltrative or solid; often contain calcifications; often associated with epilepsy; may have anaplastic form (WHO grade 3)
A283. OLIGODENDROGLIOMA, GRADE 2
Q284. NEOPLASMS DERIVED FROM VENTRICULAR LINING CELLS
A284. ependymomas and choroid plexus tumors
Q285. what brain tumor presents as follows?; MASS EFFECT, OBSTRUCTIVE HYDROCEPHALUS
A285. ependymomas and choroid plexus tumors
Q286. for ependymomas (grade 2 or 3), what is the location for:; 1. children; 2. adults
A286. 1. lateral and fourth ventricles; 2. fourth ventricle, spinal cord
Q287. for papillomas(grade 1), what is the location for:; 1. children; 2. adults
A287. 1. lateral or fourth ventricles; 2. fourth ventricle
Q288. Astrocytoma
A288. Low grade (2) glial tumor; More common in cerebral hemisphere in adults; Hits the brainstem of kids; special: Infiltrative; Progress to malignancy increases with age. 5 year survival rate; Astrocytomas can be stained with GFAP
Q289. Glioblastoma
A289. High grade glial tumor; They are more invasive and divide more rapidly than astrocytomas; special: Necrosis with Pseudopalisading; Survival is less than 1 year; Most common primary brain tumor.
Q290. Pilocytic Astrocytoma
A290. Grade 1; Slow growing, benign glial tumor of kids Does not progress to a later grade; special: Optic Nerve, cerebellum and hypothamus are affected
Q291. Oligodendroglioma
A291. Grade 2; Tumor of Oligodendrocytes; Affects Adults only; Milk and Eggs-fried egg appearance with calcifications. special: Calcifications, Epilepsy, Rare and slow growing
Q292. Ependymoma
A292. Neoplasm derived from lining of the ventricles. Low grade (II); Kids-lateral and 4th ventricles; special: May lead to hydrocephalus and has a poor prognosis. Characteristic perivascular pseudorosettes. Adults-4th and spinal cord
Q293. Choroid Plexus tumors
A293. Papillomas are the benign form; Carcinomas are the malignant form; Tumors mimic normal choroid and may overproduce CSF. special: Papillomas in kids-lateral and 4th; Adults-4th; Carcinomas are only in kids., Lateral ventricle. Rosettes
Q294. Embryonal Tumors; Primitive Neuroectodermal Tumors
A294. Embryonic Tumor; Retinoblastoma; Medulloblastoma-affects cerebellum. PNET-Cerebral Hemispheres; special: These tumors are highly metastatic, May disseminate thru the CSF; Often associated with gentic defects; Rosettes
Q295. Medulloblastoma
A295. Most common Embryonic tumor. Arises in the cerebellum; Dissemination into the subarachnoid space is common. special: These are very fast growing tumors, folks. Five year survival rate is 50%. Symptoms typically result from blockage of the 4th ventricle which leads to hydrocephalus.
Q296. Meningioma
A296. Non neuroectodermal tumor; Second most common brain tumor; Adults: Arises from arachnoid cells; Benign but mass effect causes troubles. Special: Resectable; Psammoma Bodies-calcifications commonly found in meningiomas
Q297. Schwannoma
A297. Arises from Schwann Cell; Often localized to the 8th nerve, causing an acoustic schwannoma-leads to unilateral hearing loss and vertigo; Adults; special: Bilateral form found in Neurofibromatosis 2
Q298. Mass effect
A298. Damage to the brain due the bulk of a tumor, the blockage of fluid, or excess accumulation of fluid within the skull. Mass effect often presents as seizures and dementia.
Q299. most likely brain tumor in children
A299. cerebellar tumors of the posterior fossa
Q300. most likely brain tumors in adults
A300. Adults are more likely to get tumors of the cerebral hemispheres. These include astrocytomas, meningiomas and metastases
Q301. Low grade, may cause endocrine dysfunction. Derived from Rathkes pouch
A301. Pituitary Adenoma - a sellar tumor
Q302. Low-grade but locally aggressive epithelial tumor; Derived from Rathke’s pouch
A302. Craniopharyngioma
Q303. 20-30% of all brain tumors, with greater incidence in older people, and about 85% are multiple within the CNS. Sources: lung, breast, malignant melanoma, kidney, GI tract, others; Path: solid or cystic circumscribed mass with central necrosis and prominent vasogenic edema
A303. Secondary Tumors – Metastatic cancer
Q304. Diffuse tumor cell spread through the CSF pathways, often associated with high CSF protein, hydrocephalus, involvement of multiple cranial and spinal nerve roots
A304. Leptomeningeal carcinomatosis
Q305. Acute infection in Subarachnoid space caused by virulent bac, fungi, some protozoans
A305. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
Q306. Acute inflam in SAS: examine CSF; ↑ pressure (200-500 mmH2O), ↑ protein (>50mg/dl), ↓ glucose (often<40mg/dl); leukoctosis (mostly PMNs); organism may be detectable by Gram stain, culture; spectrum of organisms varies w/age & clinical circumstances, commonly includes:; bac: strep, staph, hemophilus, neisseria, gram (–) rods, listeria, anaerobes; fungi: immunosuppresed: aspergillus, candida, mucor; environmental exposure: coccidoides, histoplasma; other: toxoplasma, ameba; pathogenic sequence: 10 colonization/infection in body; dissemination to CNS (usu hematogenous), infect meninges; acute inflammatory response in SAS; brain swelling, damage, outcome dissemination; inflam/overall response to infection may be modified by pt’s immune status, virulence of organism, effects of tx
A306. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
Q307. CNS infection?; Systemic: fever, n/v, irritability, lethargy; Meningismus: nuchal rigidity, Brudzinski sign flexion hip, knee), Kernig sign (starting from flexed (passive flexion neck knee/thigh, extension of knee resisted); Direct CNS involvement: headache, photophobia, altered consciousness, seizures, focal localizing signs
A307. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
Q308. CNS infection?; CSF findings: ↑ protein (mild), normal glucose, leukocytosis (very early: few PMNs, later: mostly lymphocytes); viral: common, includes common viruses causing URI or upper GI infections; some less virulent bacteria/other agents; non-infectious agents (cancer cells=leptomeningeal carcinomatosis,; chemicals/drugs=chemical meningitis) can produce similar syndrome
A308. Acute Lymphocytic Meningitis; (viral, “aseptic”)
Q309. Acute, usually self-limiting viral infection in SAS, characterized by lymphocytic inflammation
A309. Acute Lymphocytic Meningitis; (viral, “aseptic”)
Q310. CNS infection?; Fever, headache, signs of meningeal irritation, lethary, rash (milder than acute purulent leptomeningitis, and usu does not significantly alter consciousness)
A310. Acute Lymphocytic Meningitis; (viral, “aseptic”)
Q311. CNS infection?; CSF findings:; ↑ pressure or CSF blockage, ↑ protein (100-200mg/dl, higher w/CSF blockage), ↓ glucose (less than in acute purulent), leukoctosis (lymphocytes, monocytes); agent (organism, tumor cell) may be detectable; commonly “basal meningitis” w/mononuclear inflammation, fibrosis, +/- granulomas (depends on agent), most prominent at base of brain; progressive meningeal, fibrosis, -chronic inflammation in SAS hydrocephalus (non-obstructive), ↑ ICP, vasculitis, root/parenchymal involvement infarcts, focal deficits, cognitive decline
A311. Chronic Meningitis
Q312. Chronic inflammation in leptomeninges due to relatively indolent, persistent agent (TB, syphilis, sarcoidosis, some low-grade tumors, foreign substances)
A312. Chronic Meningitis
Q313. CNS infection?; often non-specific/non-localizing, slowly evolving (+/- heachache, +/- stiff neck, low grade fever, seizures, cognitive dysfunction)
A313. Chronic Meningitis
Q314. CNS infection?; predisposing factors: infection elsewhere (osteomyelitis, dental, sinusitis, otitis media, endocarditis, congenital heart disease), trauma skull/spine (including surgery), foreign body (catheter, gauze, bullet); bacteria, fungi, others; localized area of tissue damage & acute/chronic inflam surrounded by reactive layer; brain parenchyma may show prominent edema; Complications:; mass effect(↑ ICP, herniation; abscess rupture into ventricles or disseminate in SAS as acute purulent leptomen. infection spread to other organs or systemic (sepsis); focal permanent neurologic deficits
A314. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
Q315. Acute/chronic localized purulent or necrotizing infections due to destructive bacteria, fungi, or other organisms
A315. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
Q316. CNS infection?; Infec/inflam: Fever, malaise; Mass effects: headache, ↑ICP; Localizing signs, if brain parenchyma is involved: ex. seizures, focal deficits
A316. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
Q317. CNS infection?; Acute viral infection of brain parenchyma +/- meninges
A317. Acute Viral Encephalitis
Q318. CNS infection?; agent: HSV 1; site of involvement: -medial temporal lobes (Cowdry type A nuclear viral inclusions)
A318. Acute (meningo)encephalitis; Acute necrotizing
Q319. CNS infection?; Progressive viral infection, w/prolonged incubation following initial exposure, insidious onset, slow progression of sx, due to conventional viral agents; *prions excluded here; Sx: slowly progressive dementia or loss of particular neurologic functions
A319. Chronic (slow) viral encephalitis
Q320. 1) Acute Lymphocytic meningitis – often during 10 infection; 2)Chronic HIV encephalitis w/ progressive dementia (AIDS dementia); 3)Vacuolar myelopathy – uncommon degeneration of posterior & lateral columns in spinal cord in chronic AIDS pt, resembles subacute combined degeneration seen in vitamin B12 deficiency; 4)peripheral neuropathy (various types); 5)inflammatory myopathy (polymyositis-like)
A320. HIV: syndromes
Q321. CNS infection?; agent: CMV; site of involvement:; periventricular tissues (cytomegalic cells); occurs as congenital infection (TORCH) & immunocompromised host
A321. Acute (meningo)encephalitis; Acute necrotizing
Q322. CNS infection?; agent?; HIV; involved site: brain atrophy, demyelination, encephalitis w/monocytes & giant cells
A322. AIDS Dementia
Q323. CNS infection?; agent:; papovirus JC strain); involved site:; infection, destruction oligodendrocytes -> progressive demyelination, usu in immunocompromised host
A323. PML(progressive multifocal leukoencephalopathy)
Q324. the removal, treatment, and return of (components of) blood plasma from blood circulation. separates things based on molecular weight.
A324. Plasmapheresis
Q325. autoimmune CNS disease?; auto-antibodies attack AchR; Weakness and Muscle Fatigue; Distribution of affected muscles is variable. **Eye muscles are the 1st thing involved. Reflexes and sensation is unaffected
A325. Myasthenia Gravis
Q326. Lab Tests for MG
A326. Anti AchR antibody is 85-90% positive.
Q327. can induce Myasthenia and antibodies to AchR
A327. Thymoma and Penicillamine can induce Myasthenia and antibodies to AchR. FYI: A thymoma is a tumor of the thymus gland that leads to an autoimmune response.
Q328. Treatment Myasthenia Gravis
A328. Plasmapheresis; Pyridostigmine blocks Ach Esterase which makes more Ach available. Thymectomy
Q329. Lambert-Eaton Syndrome
A329. Autoantibodies against the presynaptic voltage-gated calcium channels; caused by circulating antibodies to Voltage gated Calcium Channels which block Ach release. Clinical Features:; Weakness and fatigability; Autonomic Dysfunction-sexual dysfunction, dry mouth,; Reflexes are depressed; 60% of cases are associated with small cell lung cancer
Q330. Lab Tests for Lambert Eaton
A330. Antibody to Voltage Gated Calcium Channels
Q331. treatment for Lambert-Eaton Syndrome
A331. Search for and treat the tumor if it’s present (often paraneoplastic syndrome of small cell lung cancer); Pyridostigmine works, but is less effective than in Myasthenia gravis (MG). Plasmaphereisis works well too.
Q332. CNS autoimmune disease?; degenerations are disorders of the cerebellum, the part of the brain responsible for coordination, which are associated with tumors (neoplasms). They arise when tumors express proteins that are normally found only in neurons, and it is believed that the immune system, in its attempt to kill the tumor, also damages the cerebellum. current thought is that "killer T-cells", or cytotoxic CD8+ T lymphocytes, are the most likely mediator of neuronal injury.
A332. Paraneoplastic Syndromes
Q333. Examination of patients with anti-Purkinje cell antibodies, especially anti-Yo, is usually dominated by a rapidly progressive unsteadiness, and downbeating nystagmus.
A333. Paraneoplastic Syndromes
Q334. rare complication of cancer characterized by chaotic, synchronous eye movements (opsoclonus), spontaneous muscle jerks (myoclonus), and ataxia.
A334. Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
Q335. autoimmune disease in CNS?; almost exclusively associated with neuroblastoma
A335. children OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
Q336. autoimmune disease in CNS?; associated with small cell lung cancer (SCLC) and breast cancer are the most frequent tumors associated; It’s also known as dancing eye, dancing feet syndrome.
A336. adult OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
Q337. Difficulty in finding works (dysnomia); Impaired visuospatial memory (misplace things ,not finding their way home); Impaired recent memory. Delusion ,insomnia, depression
A337. early sx of alzheimer's disease
Q338. Increasingly impaired remote memory; Non confluent speech; Agitation, aggression
A338. later sx of alzheimer's disease
Q339. Recent and remote memory obliterated; Mute; Severe rigidity
A339. final stage of alzheimer's disease
Q340. What disease has the following MRI features?; Marked reduction in brain volume; Cortical atrophy, frontal ,parietal; Ventricular dilatation (hydroceplus ex vacuo )
A340. alzheimer's disease
Q341. what disease is associated with the following?; Positron emission tomography (PET) : (fluorodeoxyglucose); Early changes: impaired glucose utilization in posterior cingulate gyrus and parietal cortex (cf. DLBD: anterior cingulate gyrus )
A341. alzheimer's disease
Q342. What disease has the following?; Key Pathological makers:; 1. Neurofibrillary tangles, Flame shaped; globose; 2. Senile plaques, diffuse, primitive, mature and burnt-out
A342. alzheimer's disease
Q343. What is the AD pathlogic criteria for the following ages?; < 50 years; 52-65 years; 66-75 years; 75 years & over
A343. < 50 years = 5 or more senile plaques per 200 x field. 52-65 years = 8 or more; 66-75 years = 10 or more; 75 years & over = 15 or more
Q344. What disease has the following pathogenic mechanism?; B-secretase and G-secretase cleave APP (amyloid protien) to form A-beta with 1-40 (accum. in vessel walls) or 1-42 (accum. in neurons); change in amyloid protien leads to alteration in 2nd and 3rd structure of normal protein
A344. Alzheimer's disease
Q345. what chromosomes are associated with the following AD genetic cases?; presenilin 1:; presenilin 2:; amyloid precursor protein (APP);; associated with late onset AD (sporadic).
A345. - presenilin 1: Chromosome 14; presenilin 2: Chromosome 1; amyloid precursor protein (APP); Chromosome 21; Apo-E ε 4 allele associated with late onset AD (sporadic).
Q346. what disease has the following sx?; changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating, and pain.
A346. MS
Q347. What disease requires the following for dx?; Clinical history and examination; Multiple CNS lesions in time and space; CSF examination: mild pleocytosis (5-50 lymphs) during acute attack, increased protein with high IgG, oligoclonal bands (persistent); MRI shows multiple plaques, active plaques; may enhance
A347. MS
Q348. what disease has the following common manifestations?; Optic neuritis: visual loss; Limb weakness; Sensory symptoms (paresthesias, hypesthesia); Cerebellar ataxia; Nystagmus; Diplopia (CN VI palsy or INO)
A348. MS
Q349. what disease presents as follows?; Age 15-50, but most cases start in the 20’s; Women are effected 2 times more than men; Optic Neuritis; Limb weakness which often presents as difficulty walking down stairs; Imbalance
A349. MS
Q350. what disease has the following?; CSF examination: Mild pleocytosis (increase in cell count) during an acuteü attack, Increased IgG); Oligoclonal Bands-due to high Ig levels on electrophoresis.
A350. MS
Q351. what drug used to tx MS are thought to interfere with INF Gamma which enhances attacks?
A351. INTERFERONs
Q352. what drug used to tx MS is a synthetic medication made of four amino acids that are found in myelin? This drug stimulates T cells in the body's immune system to change from harmful, pro-inflammatory agents to beneficial, anti- inflammatory agents that work to reduce inflammation at lesion sites.
A352. GLATIRAMER ACETATE: (trade name Copaxone)
Q353. what drug has been approved by the USA´s FDA for secondary progressive, progressive-relapsing, and worsening relapsing-remitting MS?
A353. MITOXANTRONE: (trade name Novantrone)
Q354. what drug used for MS is used to reduce the occurrence of clinical exacerbations. It is recombinant IgG directed against Alpha Integrin. Alpha Integrin inhibition prevents the inflammatory response?
A354. NATALIZUMAB: (trade name Tysabri)
Q355. what are 2 epidemiologic factors associated with MS
A355. -MS incidence increases with latitude. Prior to age 15, risk is correlated with geographic location.
Q356. CNS disease?; characterized by a brief but intense attack (punctate) of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. It often follows viral infection, or less often, vaccination for measles, mumps, or rubella. The symptoms come on quickly, beginning with encephalitis-like symptoms such as fever, fatigue, headache, nausea and vomiting, and in severe cases, seizures and coma.
A356. Acute disseminated encephalomyelitis (ADEM)
Q357. what CNS disease has the following pathology?; Multiple focal areas of small perivascular areas of demyelination and inflammation in white matter
A357. Acute disseminated encephalomyelitis (ADEM); **be able to distiguish from Leukodystrophy and MS
Q358. CNS disease?; Rare inherited disease which manifest as damage to myelin. Most have an early onset, are progressive and lethal. The majority are Autosomal Recessive. bilateral, symetric, and diffuse
A358. Leukodystrophy; **be able to distiguish from ADME and MS
Q359. CNS disease?; Caused by mutations or conformational changes of the prion-protein (PrPSC) or glycated PrPSC
A359. prion disorders
Q360. Formation of vacuoles in neural cytoplasm and nuclei. The size of the vacuole varies in the different sporadic forms. The vacuoles harbor the abnormal PrPSC-protein.
A360. Spongiform Degeneration:
Q361. type of amyloid plaque?; characteristic of the cerebellar form of sporadic CJD
A361. Kuru-plaques
Q362. type of amyloid plaque?; seen in the human form of bovine spongiform encephalopathy.
A362. Cortical amyloid plaques
Q363. prion disorder?; 85% of all cases (annually 1 per 1 milj) . Peak age of onset 60 – 65 years; Usually rapidly progressive dementia 4 -12 mo . With myoclonus, periodic sharp-wave EEG.
A363. Sporadic Creutzfeldt-Jakob disease
Q364. type of prion disease?; all defined by genotype at codon 129 of the prion gene. Differences in the methionine / valine polymorphism of this site and degree of protease resistance of conformationally changed protein do determine the type ,i.e., clinical symptoms and distribution of; pathology.
A364. Sporadic Creutzfeldt-Jakob disease
Q365. all cases occur with an autosomal dominant mode of inheritance. Twenty different mutations of the PrP have been identified. Each type shows a relatively uniform clinical and pathological picture.
A365. familial Creutzfeldt-Jakob disease
Q366. prion disease?; pathological picture is characterized by; spongiform degeneration, excessive gliosis and sometimes deposition of ß-pleated amyloid plaques which are made up of insoluble protease-resistant accumulation of the altered PrPSC.
A366. Creutzfeldt-Jakob disease
Q367. TYPES OF SPORADIC CJD?; clinical sign: Dementia, ataxia; EEG: Sharp waves; Pathology: Occipital-parietal cortex
A367. M/M type 1
Q368. TYPES OF SPORADIC CJD?; clinical sign: Dementia; EEG: Diffuse slowing; Pathology: Cerebral cortex
A368. M/M type 2
Q369. TYPES OF SPORADIC CJD?; clinical sign: Ataxia, Dementia; EEG: Diffuse slowing; Pathology: Cerebellum (Kuru plaques)
A369. M/V type 2
Q370. TYPES OF SPORADIC CJD?; clinical sign: Dysarthria,; dysphagia, dementia; EEG: Periodic sharp waves; Pathology: Subcortical Involvement (thalamus)
A370. V/V type 2
Q371. what effect does Pathological PrPSC have on Schematic flow of pathogenetic mechanisms in prion disorders?
A371. Β-sheet conformation/ plaques; Protease resistant disease; also, Variations due to polymorphism and glycation of PrPSC give rise to specific disease entities.
Q372. inability to produce and/or comprehend language b/c brain damage
A372. Aphasia
Q373. inability to name, .e., “word finding” difficulty
A373. Anomia
Q374. acquired impairment in reading
A374. Alexia
Q375. impairment in writing
A375. Agraphia
Q376. inability to do arithmetic
A376. Acalculia
Q377. impairment in the execution of a motor act in the absence of weakness, sensory loss, or incoordination
A377. Apraxia
Q378. type of aphasia?; speech: poor; comprehension: intact; repetition: poor
A378. broca's aphasia
Q379. type of aphasia?; speech: fluent; comprehension: poor; repetition: poor
A379. wernicke's aphasia
Q380. type of aphasia?; speech: intact; comprehension: intact; repetition: poor
A380. conducion aphasia
Q381. type of aphasia?; speech: Poor; comprehension: poor; repetition: poor
A381. global aphasia
Q382. Dominant parietal lobe lesion (angular; gyrus = area 39); Finger agnosia; Left-right disorientation; Acalculia; Alexia with Agraphia; Usually not all 4 are present
A382. Gerstmann's syndrome
Q383. Deficits due to inability to transmit information from one area of cortex to another; After a complete callosotomy the right hand does not know what the left is doing, or what is in the left visual field
A383. Disconnection syndromes
Q384. type of amnesia?; Inability to form new memories; Korsakoff's syndrome
A384. Anterograde
Q385. type of amnesia?; Loss of premorbid memories; Ribot's law: more recent memories are most affected
A385. Retrograde
Q386. Bilateral limbic system lesions; Medial temporal lobes; Medial thalamic nuclei; Usually a mixture of anterograde and retrograde amnesia; Common after traumatic brain injury
A386. Amnestic Syndrome
Q387. type of amnesia?; Acute onset profound transient anterograde amnesia; Benign usually (migraine, seizure, TIA); Leaves a permanent memory gap; Full recovery of anterograde memory
A387. Transient Global Amnesia
Q388. type of amnesia?; Loss of personal identity and past; Intact memory for recent events; Occurs most often in fiction
A388. Psychogenic Amnesia; (psychogenic fugue)
Q389. Loss of multiple cognitive abilities in a person with a clear sensorium (no delerium)
A389. Dementia
Q390. DSMIV-R requires memory impairment plus impairment in one of:; language; judgement; abstract thinking; praxis; constructional abilities; visual recognition
A390. Dementia
Q391. Memory complaint, preferably corroborated by an informant; Objective memory impairment; Normal general cognitive function; Intact activities of daily living; Not demented
A391. Mild Cognitive Impairment Criteria
Q392. lesion: Left occipital and splenium of CC; associated deficits: Right hemianopia, color anomia or achromatopsia
A392. Alexia without Agraphia
Q393. lesion: Left hemisphere, angular gyrus; associated deficits: Right hemisensory, hemiparesis, and aphasia
A393. Alexia with Agraphia
Q394. Blind but preserved PLR
A394. Cortical Blindness
Q395. cortical blindness with anosognosia
A395. Anton’s Syndrome
Q396. type of syndrome?; Oculomotor apraxia—saccades; Optic ataxia—visually guided limb movements,; Simultanagnosia—foreground/background; Sometimes prosopagnosia—face recognition
A396. Balint’s syndrome
Q397. drug class used to tx AD?
A397. cholinesterase inhibitors should be considered for mild to moderate AD; donepezil (aracept); rivastigmine (exelon); galantamine (renimyl)
Q398. What disease do the following relate to?; Memory loss that affects job skills; Difficulty performing familiar tasks; Problems with language; Disorientation to time and place; Poor or decreased judgment; Problems with abstract thinking; Misplacing things; Changes in mood or behavior; Changes in personality; Loss of initiative
A398. Ten Warning Signs of AD
Q399. What disease requires the following evaluation?; Complete blood cell count; Serum electrolytes; Glucose; BUN/creatinine; Serum B12 levels; Liver function tests; Thyroid function tests; Depression screening
A399. Routine Evaluation of the; Demented Patient
Q400. drug?; indicated for the treatment of moderate to severe dementia of the Alzheimer's type (FDA); a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist
A400. Memantine (Namenda)
Q401. T or F?; Estrogen should be prescribed to treat AD
A401. False
Q402. type of headache?; Recurring headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of headache are unilateral location, pulsating quality, moderate or; severe intensity, aggravation by routine physical activity, and association with nausea, photo- and phonophobia
A402. Migraine without aura
Q403. type of headache?; Headache has at least two of :; Unilateral location; Pulsating quality; Moderate or severe intensity; Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs); During headache at least one of :; Nausea and/or vomitng; Photophobia and phonophobia
A403. Migraine without aura
Q404. type of headache:; least one of the following, but no motor weakness:; 1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/or negative features (ie, loss of vision); 2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness); 3. fully reversible dysphasic speech disturbance; At least two of the following:; 1. homonymous visual symptoms and/or unilateral sensory symptoms; 2. at least one aura symptom develops gradually over ≥5 minutes; and/or different aura symptoms occur in succession over ≥5 minutes; 3. each symptom lasts ≥5 and ≤60 minutes; Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes
A404. Typical aura with migraine headache
Q405. Warning signs in headache
A405. First & worst headache comes to the ER: needs a CT & LP to rule out subarachnoid hemorrhage (SAH); Headaches that awaken a patient at night or occur first thing in the morning suggest increased ICP; Palpable tender temporal arteries suggest GCA: check ESR; Cherry-red headache patients in winter: think CO; Virtually all headaches can cause nausea & vomiting
Q406. Headaches that awaken a patient at night or occur first thing in the morning is suggestive of what?
A406. suggest increased ICP
Q407. Palpable tender temporal arteries suggest GCA, check for what?
A407. ESR
Q408. clinical characteristic of virtually all headaches?
A408. Virtually all headaches can cause nausea & vomiting
Q409. Cherry-red headache patients in winter
A409. think CO
Q410. type of headache?; Excrutiating, penetrating, non-throbbing pain unilaterally, usually in the trigeminal distribution; Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, & ptosis; Peaks in 10-15 minutes, lasts 45-60 minutes; Occurs 1-3 times per day during cluster, often nocturnal; Typical cluster lasts 2-3 months and occurs every year or two; Affect men more often than women, 4-7:1
A410. Cluster Headache
Q411. type of headache?; Diffuse, bilateral, pressing or “tightening” quality, “like a band around the head”; Mild to moderate in severity; Usually episodic, may become chronic; Phonophobia, photophobia, or mild nausea occur rarely; Not really due to muscle tightness; Prevalence is 69% for men, 88% for women
A411. Tension-type Headache
Q412. Migraine is a _______ disorder
A412. neurovascular
Q413. what system is activated when Local vasodilatation of intracranial extracerebral blood vessels occurs; causes the release of vasoactive sensory neuropeptides, especially CGRP, that increase the pain response
A413. 'trigeminovascular system'; The activated trigeminal nerves convey nociceptive information to central neurons in the brain stem trigeminal sensory nuclei
Q414. drugs to tx migrane?; cause vasoconstriction through 5-HT1B receptors that are expressed in human intracranial arteries; inhibit nociceptive transmission through an action at 5- HT1D receptors on peripheral trigeminal sensory nerve terminals in the meninges and central terminals in brain stem sensory nuclei
A414. The 'triptan' anti-migraine agents (e.g. sumatriptan, rizatriptan, zolmitriptan, naratriptan) are serotonergic agonists
Q415. What should be avoided to abort a migraine except in the ER?
A415. Avoid narcotics except in ER
Q416. what is the specific tx for cluster headaches?
A416. 100% oxygen, ipsilateral intranasal 4% lidocaine for cluster headache
Q417. prophylaxis for migraine therapy
A417. Dietary: find precipitants; Caffeine, chocolate, nuts, aged cheeses, processed meats, alcohol (especially red wine); Beta blockers (especially propranolol); Daily naproxen; Calcium channel blockers; Amitriptyline and other tricyclics; Valproic acid (Depakote); Prednisone (short course) to break status migrainosus or cluster; Lithium for cluster headaches
Q418. type of headache?; Signs and symptoms of increased intracranial pressure without hydrocephalus; Usually small, slit-like ventricles; Mean age at onset 30 years, F:M 9:1; 90% of patients are obese, also associated with endocrinopathies, pregnancy, oral contraceptives, steroids, lithium, tetracycline, vitamin A intoxication
A418. Pseudotumor cerebri
Q419. What type of headache presents 100% of the time with papilledema?
A419. Pseudotumor cerebri
Q420. What type of headache requires the following treatment?; Weight loss; Acetazolamide; If there is progressive visual loss:; Optic nerve sheath fenestration; Lumbar-peritoneal shunting
A420. Pseudotumor cerebri
Q421. type of headache?; Paroxysmal, severe lancinating unilateral pain in the distribution of one or more branches of the trigeminal nerve; Episodes last <30-60 seconds evoked by stimulation of trigger points by touch, chewing or talking; Age is >40 years in 90%, F:M 3:2; Examination is normal
A421. Trigeminal Neuralgia or Tic Doloreux
Q422. what drugs are effective in 70-80% of cases in treating trigeminal neuralgia?
A422. Carbemazepine and phenytoin
Q423. what headache type can be treated in one of the following ways?; Carbemazepine and phenytoin each are effective in 70-80% of cases; • Tricyclics, baclofen, clonazepam, valproic acid, gabapentin can also be effective; Surgical treatments include microvascular decompression, percutaneous radiofrequency ablation of the trigeminal ganglion, local neurolysis and trigeminal rhizotomy
A423. Trigeminal Neuralgia
Q424. type of headache?; Patients are usually >60 years old Symptoms:; headache, often in temporal or occipital areas; fever, malaise, weight loss; jaw claudication; sudden vision loss Signs and findings; tenderness over the temporal arteries; elevated ESR; vasculitis on biopsy Treatment: oral prednisone
A424. Giant Cell or Temporal Arteritis
Q425. location of diffuse astrocytoma in adults?
A425. AGE/LOCATION:; adults: most common in cerebral hemispheres
Q426. location of diffuse astrocytoma in children?
A426. children: most common in brainstem, diencephalon (thalamus, hypothalamus)
Q427. sx of a lacunar thalamic stroke
A427. sensory
Q428. sx of a lacunar pontine stroke
A428. dysarthria, clumsy hands
Q429. most common locations for a berry aneurysm in brain
A429. pca > aca > mca
Q430. medical tx for SAH
A430. CCB to prevent vasospasms; gradually decrease BP
Q431. complications of SAH
A431. 30% re-rupture; 50% vasospasm
Q432. which way do eyes deviate in a stroke involving the pons
A432. away
Q433. which way do eyes deviate in a stroke involving the cortex
A433. towards
Q434. which way do eyes deviate in a stroke involving the thalamus
A434. eyes deviate downwards
Q435. most common cause of ICP
A435. sudden increase in BP
Q436. most common cause of SAH
A436. ruptured aneurysm
Q437. most common cause of ischemic stroke
A437. embolic stroke
Q438. most common cause of lacunar stroke
A438. microathetroma and lipohylinosis; in small penetrating arteries of brain
Q439. where is the lesion:; paralysis of left side of tongue with right limb weakness
A439. paramedian medulla oblongata
Q440. where is the lesion:; left facial pain, vertigo and vomiting at onset with loss of pain and temp in L face; loss of pain and temp in R limbs adn trunk; L horner's syndrome; dysphagia
A440. wallenberg syndrome; (2/2 PICA or vertebral artery branch infarct)
Q441. where is the lesion:; left 3rd nerve palsy and right hemiplegia; (if awake); if unconscious
A441. midbrain involving basis pedunculi and cn III; left cerebral mass lesion with increased icp
Q442. where is the lesion:; left 3rd nerve palsy with involuntary movements and incoordination of right limbs
A442. midbrain involving red nucleus and cn iii
Q443. cogwheel rigidity; tremor at rest; postural instability; Lewy bodies; depigmentation of Snc
A443. PARKINSON'S; possible link to MPTP
Q444. contralateral subthalamic nucleus damage
A444. hemiballismus
Q445. Huntington cerebral appearance
A445. caudate atrophy; enlarged ventricles; (loss of GABAergic neurons)
Q446. depression; chorea; progressive dementia; chromosome 4 defect
A446. Huntington
Q447. Friedrich's ataxia; inheritance; defect; sx
A447. auto Recessive; GAA repeat; ataxia; hypertrophic cardiomyopathy; spasticity; loss of joint sensation; decreased joint sensation; posterior spinal cord; spasticity; lateral spinal cord
Q448. Werdnig-Hoffman; inheritance; defect; sx
A448. auto recessive; anterior horn LMN degeneration; floppy baby; spinal muscular atrophy; tongue fasiculations; death median 7 mts
Q449. severe abdominal pain; psychosis; peripheral neuropathy; dementia
A449. Acute intermittent prophyra; autoD; (-)uroporphyrogen snythase; PBG, delta-ALA accumulation; wine urine on oxidation
Q450. Acute intermittent porphyra; inheritance; defect; accumulation; sx
A450. autoD; (-)uroporphyrogen synthase; PBG, delta-ALA accumulation; wine urine on oxidation; severe abdominal pain; psychosis; peripheral neuropathy; dementia
Q451. Broca lesion
A451. expressive aphasia; difficulty speaking; understanding intact
Q452. fluent speech; difficulty understanding; poor repetition
A452. Wernicke's receptive aphasia; neologisms
Q453. fluent speech; good understanding; poor repetition
A453. Arcuate conduction aphasia
Q454. poor speech; good understanding; poor repetition
A454. Broca's expressive aphasia
Q455. fluent speech; difficulty understanding; repetition intact
A455. transcortical sensory
Q456. poor speech; difficulty understanding; repetition intact
A456. transcortical mixed; can only repeat
Q457. poor speech; difficulty understanding; poor repetition
A457. global; profound; nonverbal
Q458. bilateral amygdala lesion
A458. amygdala-la land of sex; Kluver-Bucy syndrome; disinhibition; hyperorality; hypersexuality
Q459. Frontal lobe lesion
A459. disinhibition; mood changes; difficulty concentrating
Q460. parietal lobe lesion
A460. contralateral hemineglect
Q461. Midbrain reticular activating system
A461. reduced arousal, activity
Q462. bilateral mammary bodies
A462. Wernicke-Korsakoff; ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia
Q463. ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia
A463. Wernicke's-Korsakoff
Q464. truncal ataxia; poor motor speech/dysarthria
A464. cerebellar vermis
Q465. contralateral hemiballismus
A465. subthalamic nucleus; basal ganglia
Q466. anterograde amnesia
A466. hippocampus
Q467. paramedian pontine reticular formation (PPRF); location; unilateral lesion
A467. pons; eyes look AWAY from side of lesion; contralateral gaze deviation; uPP(RF) and AWAY
Q468. Frontal eye fields lesion
A468. inability to initiate voluntary mvmt; eyes look TOWARDS lesion; sit TOWARDS the FRONTal
Q469. Broca's area location
A469. inferior frontal gyrus
Q470. Wernicke's location
A470. superior temporal gyrus
Q471. contralateral loss of pain, temp; visual field loss w/ macular sparing; ispilateral oculomotor nerve palsy hemiparesis,hemiplegia. Horner's
A471. PCA; midbrain; optic tracts; thalamus
Q472. foot and leg paralysis; foot and leg sensory loss; gait disturbance; transcortical motor aphasia; (left stroke)
A472. contralateral ACA; (stroke prior to the anterior communicating artery okay b/c collateral circulation)
Q473. face-trunk-arm paralysis; face-trunk-arm loss of sensation; Broca's/Wernicke's aphasia; hemineglect (parietal lobe); vision loss
A473. contralateral MCA
Q474. oculomotor palsy
A474. posterior communicating artery; PCA
Q475. bitemporal hemianopsia
A475. Acomm a. aneurysm; Pituitary adenomas; Craniopharyngiomas.
Q476. pure motor hemiparesis following stroke; artery; patholocation
A476. lateral striate/ MCA; lacunar infarct of internal capsule
Q477. severe vertigo; nystagmus; ipsilateral ataxia; difficulty swallowing; Horner's
A477. PICA
Q478. paralysis of all extremities; profound loss of sensation; respiratory difficulty
A478. basilar artery infarct; "locked in syndrome"
Q479. nuchal rigidity; worst headache of life; bloody, xanthrochromic tap
A479. subarachnoid hemorrhage; berry aneurysm rupture; AVM
Q480. cresentic hematoma; crosses sutures; delayed onset of symptoms; flux of consciousness; bridging veins; elderly, alcohol, shaken baby; whiplash
A480. subdural hematoma
Q481. hematoma crosses falx, tentorum
A481. epidural
Q482. hematoma crosses suture
A482. subdural
Q483. () biconvex hematoma; lucid interval; middle meningeal artery; temporal bone fracture
A483. epidural hematoma; middle meningeal artery
Q484. hydrocephalus; paralysis of upward gaze; dilated lateral, munro, 3rd ventricle
A484. congenital stricture of aqueduct of sylvius
Q485. dilated lateral, munro, 3rd ventricle, sylvian aqueduct, 4th ventricle
A485. Dandy Walker; foramen of Luschka, Magendie stenosis
Q486. spinal tap structures are pierced ...
A486. SLED SAS; skin/superficial fascia; ligaments:; supraspinatus; interspinatous; flavus; epidural space; dura mater; subdural space; arachnoid; subarachnoid space
Q487. LMN destruction in anterior horn
A487. Polio; Werdnig-Hoffmann
Q488. asymmetric diffuse spinal and cortical lesions in white matter
A488. MS
Q489. lesions in ventral column; anterior horn; corticospinal
A489. ALS; axial motor defects (ant horn); UMN/LMN motor defects (corticospinal)
Q490. anterior spinal artery occulsion
A490. spares dorsal column; anterior horn; corticospinal tract; spinothalamic tract
Q491. posterior spinal artery occlusion
A491. dorsal column
Q492. degeneration of dorsal roots, columns; disease; sx
A492. tabes dorsalis; locomotor ataxia, (proprioception); impaired touch
Q493. degeneration of region between anterior horn; disease; sx
A493. syringomyelia; bilateral loss of pain and temperature sensation; damages crossing fibers of spinothalamic tract
Q494. dorsal column; lateral corticospinal; spinocerebellar tracts; demylenation; disease; sx
A494. B12 defiency; Fridrick's ataxia; hyperreflexia; neuropathy; ataxia; impaired position sense
Q495. anterior horn destruction; fasciculations, fibrillation; muscle weakness, atrophy; CSF lymphocytic pleocytosis
A495. poliomyelitis; virus replicates in oropharyx, intestines; cx from stool, throat
Q496. anterior horn destruction; floppy baby; tongue fasiculations; death at 7 mths
A496. Werdnig-Hoffman
Q497. superoxide dismutase defect; hand atrophy; spasticity; weakness; +babinski
A497. ALS
Q498. rapid sensory motor loss; immunocompromised state; oligocyte inclusions; disease, agent
A498. progressive multifocal leukoenephalopathy; JC virus
Q499. parkinsonism; putamen/basal ganglia; atrophy, cavitary necrosis; hyperpigmentation; liver cirrhosis
A499. Wilson's disease
Q500. history of measles; personality change, seizures, myoclonus, ataxia, photosensitivity,; progressive psychomotor decline/death; oligodendrocyte inclusions
A500. subacute sclerosising panencephalitis; chronic measles infection
Q501. loss of joint sensation; shooting pain; history of sexual activity; loss of DTR; locomotor ataxia
A501. tabes dorsalis
Q502. staggering gait; nystagmus; hypertrophic cardiomyopathy; childhood kphoscoliosis; familial frataxin gene repetition
A502. Friedrich's ataxia
Q503. trauma, TB, MS; Hemiparaplesia; ispi UMN symptoms; ipsi loss of touch, vibration below; loss of all motor/sensation at lesion; contralateral loss of pain, T; +/- Horner's symptoms (above T1)
A503. hemisection of spinal cord; Brown-Sequard
Q504. HIV; periventricular calcifications; intranucelar basophlic inclusions
A504. CMV meningitis
Q505. Horner's syndrome; sx; lesion
A505. ptosis; miosis; anhydrosis; spinal cord lesion above T1
Q506. history of MS; normal convergence; nystagmus on abduction of eye; medial rectus palsy on lateral gaze
A506. MLF syndrome; medial longitudinal fasculus lesion
Q507. sudden loss of vision; MLF; hemiparesis/sensory sx; bladder/bowel incontinence; scanning speech; intention tremor; nystagmus
A507. MS
Q508. MS associated with what HLA class
A508. DR2; 2 Drs can't cure MS
Q509. postviral; acute perivenular inflammation; demyleination
A509. acute disseminated encephalomyelitis
Q510. Metachromatic leukodystophy; inheritance; deficiency; accumulated substance; disease
A510. autorecessive; arylsulfatase A deficiency; sulfatides buildup; impaired myelin sheath
Q511. CNS symptoms with; adrenal insufficiency; familial
A511. Adrenoleukodystrophy; autorecessive; LCFA buildup destroys myelin
Q512. unilateral periorbital pain; brief repetitive headaches; ipsilateral lacrimation; rhinorrhea; Horner's
A512. cluster headache
Q513. medullary cerebral vermis herniation through foramen magnum; dilation of lateral, 3rd, sylvian duct; flatten base of skull; meningomyocele, syringomelia
A513. Arnold Chiari
Q514. vermis hypoplasia; cystic dilation of lateral, 3rd,sylvian, 4th ventricles,; hydrocephalus; obstructed foramen Luska/Magn
A514. Dandy Walker
Q515. loss of pain, T in hands; atrophy of intrinsic hand muscles; fluid filled cervical cord enlargement; anterior horn destruction; +/- Chiari herniation
A515. syringomyelia
Q516. port wine stains; leptominingeal angioma, AVM; glaucoma; seizure; hemiparesis; MR
A516. Sturge-Weber
Q517. cafe au lait; pigmented iris harmartomas; neurofibromas; auto d
A517. neurofibromatosis 1
Q518. cavernous hemangiomas; RCC; hemangioblastoma in retina
A518. VHL
Q519. corticocerebellar atrophy; central pontine myelosis
A519. alcholism
Q520. mouth drop; difficulty speaking; inability to close eye; unilateral facial paralysis
A520. Bell's palsy
Q521. Bell's palsy; unilateral causes; bilateral causes
A521. HIV, Sarcoidosis; bilateral = LYME
Q522. + GFAP; pseudopalisading tumor; central necrosis, hemorrhage; can cross corpus callosum
A522. GBM astrocytoma
Q523. spindle cells; arachnoid cell origin; can invade bone; psammoma bodies
A523. meningioma
Q524. chicken wire capillaries; frontal lobe calcification; fried egg cells
A524. olgiodendroglioma
Q525. Positive GFAP; posterior fossa; eosinophilic corkscrew rosenthal fibers; cystic
A525. pilocystic astrocytoma
Q526. neuroectodermal; can compress 4th ventricle; hydrocephalus; rosettes, perivascular pseudorossets
A526. medulloblastoma
Q527. perivascular pseduorosettes; rod shaped basal ciliary bodies near nucelus; hydrocephalus if in 4th ventricle
A527. ependymoma
Q528. vascular tissue; foamy cells; polycythemia; associated with VHL; cerebellar
A528. hemangioblastoma
Q529. dilated pupils; eye down adducted; ptosis; herniation of medial temporal lobe; occipital infarct
A529. uncal herniation
Q530. tonic clonic first line
A530. phenytoin; carmnbamazepime; depakote
Q531. absence first line
A531. ethosuximide; (depakote ok)
Q532. phenytoin; MOA; toxicity
A532. Na channel inactivation; nystagmus, gingival hyperplasia; decreases warfarin
Q533. BDZ; MOA; toxicity
A533. increase GABA conc; sedation, dependence
Q534. Carbamazepine; MOA; toxicity
A534. Na channel inactivation; teratogenic, agranulocytosis, aplasic anemia, diplopia, hepatotoxicity
Q535. Phenobarbital; MOA; toxicity
A535. increases GABA a activity; dependence; decreases warfarin
Q536. Valproic acid; MOA; toxicity
A536. Na channel inactivation, increases GABA; teratogenic; weight gain; fatal hepatotoxcicity; spina bifida; inhibits phenobarital metabolism
Q537. Lamotrigine; MOA; toxicity
A537. blocks Na channels; Steven Johnsons
Q538. Gabapentin; MOA
A538. GABA analog
Q539. Topiramate
A539. blocks Na channels; renal stones; mental dullness; weight loss
Q540. Ethosuximide
A540. blocks thalamic T-Ca channels
Q541. Dantrolene MOA
A541. prevents release of Ca from SR of skeletal muscle
Q542. Bromocriptine; MOA
A542. dopamine receptor agonist
Q543. Amantadine; MOA
A543. increases dopamine release
Q544. Ldopa/carbidopa; MOA
A544. increases dopamine concentration in synapse
Q545. Selegline; MOA
A545. selective MAO B inhibitor; prevents dopamine degradation
Q546. Benztropine
A546. antimuscarinic (like atropine); improves parkinsonian tremor
Q547. Ldopa overdose give _________
A547. clozaprine
Q548. Memantine
A548. NMDA receptor antagonist; prevents excitotoxicity in Alzhemier's
Q549. Donepezil
A549. Ach inhibitor for parkinsons
Q550. dilated pupil; +tachy, hypertension; tremor, seizure; overdose on _________?
A550. cocaine; amphetamine; caffiene; pseudoephedrine
Q551. dilated pupil; hypervigilence; agitation; hallucination; delirum, coma
A551. antihistamine; TCA; atropine; scopolamine; Jimson weed; antiparkinsonins
Q552. dilated pupil; hyperthermia, tachy, htn; agitation, nystagmus
A552. PCP (vertical nystagmus); LSD; mescaline; MDMA
Q553. seizure; chorea; arrhythmia; tachycardia; hyper-->hypotension
A553. TCA overdose
Q554. hypothermia; bradycardia; CNS depression; hyporeflexia; pulm edema
A554. heroin; oxycodone; morphine; meperidine
Q555. confusion; coma; salivation; incontenence; diaphroesis; bronchoconstriction; fasciulation
A555. organophosphates; pilocarpine; phyostigme; edrophonium; bethanecol