Mfy Neurology For Usmle Step2

Front 1

Parkinson's Disease -
What is it

Back 1

ACh and dopamine must be
in balance for normal,
balanced movement
dec. levels of dopamine
in substantia nigra
idiopathic hypokinetic

Front 2

When does it start

Back 2

usu. starts ~50-60 y/o

Front 3

Life expectancy

Back 3

life expectancy ~ 9 yrs.

Front 4

Parkinson's Disease -

Back 4

Most cases are idiopathic

Front 5

Insults that lead to
"parkinsonism"

Back 5

insults dec. dopamine -
postencephalitic

Front 6

toxic insults -

Back 6

(carbon disulfide
manganese
MPTP)

Front 7

others

Back 7

bihemispheric ischemic
traumatic
iatrogenic (neuroleptic meds)

Front 8

Parkinson's Disease -
History/PE

Back 8

Tremor at rest (pill rolling)

Front 9

PD History/PE

Back 9

cogwheel rigidity

Front 10

PD History/PE

Back 10

bradykinesia

Front 11

PD History/PE gait

Back 11

festinating(Sinirlilikten gelen hızlı yürüme eğilimi) gait

Front 12

PD History/PE posture

Back 12

stooped posture

Front 13

PD History/PE posture

Back 13

unstable posture

Front 14

PD History/PE face

Back 14

masked facies

Front 15

PD History/PE memory ?

Back 15

memory loss

Front 16

PD History/PE writing

Back 16

micrographia

Front 17

PD History/PE

Back 17

shy-dragger-
any autonomic dysfunction

Front 18

Parkinson's Disease -
Tx 1st -

Back 18

is it from a secondary cause
that can be reversed?

Front 19

Parkinson's Disease -
Tx then -
2nd question

Back 19

how does pt. function daily?

Front 20

tremor but functioning -
> 60 y/o

Back 20

tremor but functioning -
> 60 y/o - amantidine

Front 21

tremor but functioning -

< 60 y/o -

Back 21

tremor but functioning -

< 60 y/o - anticholinergic

Front 22

PD tx if can't function -

Back 22

l-dopa-carbidopa
most effective
but most side effects

Front 23

l-dopa-carbidopa most side effects

Back 23

"response fluctuations"

Front 24

Tx fluctuations -

Back 24

COMT or selegiline

Front 25

list of meds -

Back 25

L-dopa/carbidopa - mainstay
bromocriptine
selegiline
entacapone (COMT inhib)
amantadine & anticholinerg -
limited efficacy

Front 26

If meds fail & dis. advanced-

Back 26

deep brain stimulation of
GPi and subthal nucleus,
or pallidotomy -
ablation of GPi
(posteroventral GP)
rarely done now

Front 27

Huntington's -

Back 27

Hyperkinetic

Front 28

Huntington's - genetics

Back 28

AD

Front 29

Huntington's - brain part

Back 29

atrophy of caudate

Front 30

Huntington's - biochemistry

Back 30

lose GABA

Front 31

Huntington's - genetics

Back 31

CAG triple repeats on C4p
anticipation -
prog. expansion
> 39 repeats - mutant genes

Front 32

Huntington's -
History/PE

Back 32

Presents ~30-50 y/o
gradual onset of -
chorea
dementia
altered behavior
depression

Front 33

Huntington's -
Dx

Back 33

Clinical
CT
MRI
molecular genetic testing

Front 34

Huntington's -
Tx

Back 34

No cure
disease cannot be halted
genetic counseling

Front 35

Huntington's -
Tx - psychosis

Back 35

haloperidol

Front 36

Huntington's -
Tx minimize unwanted movements

Back 36

reserpine -

Front 37

MCC of dementia in elderly

Back 37

Alzheimer's -

Front 38

Alzheimer's -
What is it • senile plaques

Back 38

- B amyloid

Front 39

Alzheimer's - • neurofibrillary tangles -

Back 39

abnorm phosphorylated tau protein

Front 40

Alzheimer's - • loss of ACh in cortex -

Back 40

basal nucleus of Meynert

Front 41

Alzheimer's - • amyloid angiopathy

Back 41

=> lg lobar hemorrhage

Front 42

Alzheimer's - brain localisation

Back 42

• hippocampus affected early

Front 43

Alzheimer's -
Risk factors - most important

Back 43

Age

Front 44

Alzheimer's -
Risk factors syndrome

Back 44

family history
Down's (> 35 y/o)

Front 45

Alzheimer's -
Risk factors

Back 45

female gender

Front 46

Alzheimer's -
Risk factors chromosomes

Back 46

21, 14

Front 47

Alzheimer's -
Risk factors chromosome 1 -

Back 47

younger age

Front 48

Alzheimer's -
Risk factors chromosome 19

Back 48

- older

Front 49

Alzheimer's -
Risk factors genetics of high rate of Alzheimer's

Back 49

homozygous for ApoE4 -

Front 50

Alzheimer's -
????usually 1st sign
then ?????deficits

Back 50

Amnesia usually 1st sign
then language deficits

Front 51

Alzheimer's -
History/PE

Back 51

Amnesia usually 1st sign
then language deficits
acalculia
depression
agitation
apraxia

Front 52

Alzheimer's -
Evaluation Dx

Back 52

Dx of exclusion
def. Dx only on autopsy

Front 53

Alzheimer's -
Evaluation MRI or CT -

Back 53

diffuse cortical
and subcortical atrophy

Front 54

Alzheimer's -
Evaluation Neuropsych testing -

Back 54

distinguish between
dementia and depression

Front 55

Alzheimer's -
Tx mentality

Back 55

Supportive therapy

Front 56

Alzheimer's -
Tx first-line therapy

Back 56

Cholinesterase inhibitors -

Front 57

Cholinesterase inhibitors -

Back 57

donepezil
rivastigmine
galantamine

Front 58

Alzheimer's - may slow cognitive decline

Back 58

Vit E (a-tocopherol) -

Front 59

Alzheimer's -
Complications

Back 59

death usually secondary to
aspiration pneumonia or
other infections

Front 60

Alzheimer's - death

Back 60

Survival is 5-10 yrs from
onset of sxs

Front 61

Delirium -
What is it

Back 61

impairment of consciousness -
dec. awareness of your envi
can't maintain attention

Front 62

Delirium -
What is it caused by

Back 62

Caused by acute illness,
infection or drug toxicity

Front 63

Delirium -
Timing of onset

Back 63

Sudden onset

Front 64

Delirium -

Course

Back 64

Reversible (usually)

Front 65

Dementia -
What is it caused by
Timing of onset
Course

Back 65

Caused by anatomic changes
in the brain
Slow, gradual onset
Irreversible

Front 66

Subarachnoid Hemorrhage -
What is it
MCC

Back 66

Due to bleeding
from ruptured aneurysm
MCC - head trauma
(Circle of Willis)
(considered separate d/o)
spontan - ruptured aneurysm

Front 67

Subarachnoid Hemorrhage -
spontan -

Back 67

(Circle of Willis)
(considered separate d/o)
ruptured aneurysm
usually congenital berry
associated with APKD,
coarctation of aorta

Front 68

Subarachnoid Hemorrhage -
other cause

Back 68

- AV malformation

Front 69

Subarachnoid Hemorrhage -
age of onset

Back 69

~50-60 y/o

Front 70

Subarachnoid Hemorrhage -
mortality

Back 70

high mortality

Front 71

Subarachnoid Hemorrhage -
History/PE onset

Back 71

Sudden-onset headache

Front 72

Subarachnoid Hemorrhage -
History/PEjeneric sentences

Back 72

"worst headache of my life"

Front 73

Subarachnoid Hemorrhage -
History/PE

Back 73

loss of consciousness
fever
n/v
neck stiffness
seizure

Front 74

Subarachnoid Hemorrhage -
History/PE CN3 palsy -

Back 74

if berry aneurysm
may be preceded by
milder sentinel headaches
weeks earlier

Front 75

Subarachnoid Hemorrhage -
Dx

Back 75

CT without contrast immed.

Front 76

Subarachnoid Hemorrhage -
Dx CT

Back 76

blood appears white

Front 77

Subarachnoid Hemorrhage -
Dx if CT neg -

Back 77

LP immediately
ck for xanthochromia

Front 78

Subarachnoid Hemorrhage -
Dx no LP if...... why

Back 78

inc. ICP -
sudden dec. in CSF pressure
can cause further bleeding

Front 79

Subarachnoid Hemorrhage -
Dx to pinpoint location

Back 79

4-vessel angiography

Front 80

Subarachnoid Hemorrhage -
Tx to Prevent 2nd rupture -

Back 80

Prevent 2nd rupture -
most likely in 1st 48 hrs
obliterate aneurysm

Front 81

Subarachnoid Hemorrhage -
Tx

Back 81

IV fluids
keep BP OK

Front 82

Subarachnoid Hemorrhage -
Tx to prevent vasospasm

Back 82

nimodipine

Front 83

Subarachnoid Hemorrhage -
Tx to prevent seizure

Back 83

phenytoin

Front 84

Subarachnoid Hemorrhage -
Tx to lower ICP -

Back 84

raise head of bed,
hyperventilation

Front 85

Subarachnoid Hemorrhage -
Tx surgery -

Back 85

clip aneurysm
IR (stent-assisted) coiling

Front 86

Subarachnoid Hemorrhage -
Tx pain meds -

Back 86

no NSAIDs

Front 87

Subarachnoid Hemorrhage -
Complications 2nd rupture -

Back 87

esp. with aneurysm

Front 88

Subarachnoid Hemorrhage -
Complications extend into brain parenchyma-

Back 88

esp. with AVM

Front 89

Subarachnoid Hemorrhage -
Complications others

Back 89

arterial vasospasm
obstructive hydrocephalus

Front 90

Epidural Hematoma -
Often due to???? trauma
usually ??????? fracture
tear of ????????????Art.

Back 90

Often due to blunt trauma
usually lateral skull fracture
tear of Middle Meningeal Art.

Front 91

Epidural Hematoma -
History/PE Lucid interval

Back 91

- min. to hrs.
then headache
progressive obtundation
hemiparesis
"blown pupil"

Front 92

"blown pupil"

Back 92

A mydriatic pupil will remain excessively large even in a bright environment and is sometimes colloquially referred to as a "blown pupil"

Front 93

Epidural Hematoma -
Dx

Back 93

CT -

Front 94

Epidural Hematoma - CT -
????shaped hyperdensity

Back 94

lens-shaped
convex hyperdensity
close observation and
serial neuro exams
before surgery

Front 95

Epidural Hematoma -
Tx

Back 95

Neurosurgical evacuation

Front 96

Subdural Hematoma -
What is it

Back 96

Usually after head trauma
rupture of bridging veins
cortex to dural sinuses
esp. elderly & alcoholics

Front 97

Subdural Hematoma -
History/PE

Back 97

Headache
change in mental status -

Front 98

Subdural Hematoma -

Back 98

days to weeks
can present as dementia
in elderly
contralateral hemiparesis
may have remote h/o fall

Front 99

Subdural Hematoma -
Dx

Back 99

CT -

Front 100

CT -

Back 100

crescent-shaped
concave hyperdensity

Front 101

Subdural Hematoma -
Tx

Back 101

Neurosurgical evacuation
blood may regress spontan-
eously if chronic
corticosteroids
phenytoin

Front 102

Parenchymal Hemorrhage -
Causes

Back 102

HTN (usually in basal ganglia)
tumor

Front 103

Parenchymal Hemorrhage -
Causes - elderly

Back 103

amyloid angiopathy

Front 104

Parenchymal Hemorrhage -
Causes vascular malformations -

Back 104

AVM
cavernous hemangiomas

Front 105

Parenchymal Hemorrhage -
History/PE

Back 105

lethargy
headache
focal mtr & sensory deficits
some obtundation

Front 106

Parenchymal Hemorrhage -
Dx

Back 106

CT without contrast
check for mass effect
or edema

Front 107

Parenchymal Hemorrhage -
Tx

Back 107

Raise head of bed
antiseizure prophylaxis
neurosurgical evacuation -
if mass effect
esp. in posterior fossa

Front 108

Coma -
What is Rule of 4

Back 108

1. Thiamine, D50, naloxone
coma cocktail

Front 109

Coma -
What is Rule of 4

Back 109

2. 2 mechanisms
bilateral hemisphere or
RAS

Front 110

Coma -
What is Rule of 4

Back 110

3. 3 general dis. processes
structural
metabolism
seizures

Front 111

Coma -
What is Rule of 4

Back 111

4. 4 key aspects to exam

Front 112

Coma -
General Processes: Structural

Back 112

Hematoma
Infarction
Abscess
Tumor
Abnormal imaging lesion
that occupies space

Front 113

Coma -
General Processes: Metabolism

Back 113

Electrolyte, endocrine or
metabolic functions
substrate deprivation -
O2, glucose
vitamin deficiency
organ failure - kidney
toxins -
meds
etoh
drugs
infections
inflammatory dis.
Normal imaging

Front 114

Coma -
General Processes: Seizures

Back 114

Status epilepticus
postictal

Front 115

Coma -
4 aspects of exam

Back 115

Pupils
eye movement
motor response
ventilation pattern -
acid-base status

Front 116

Coma - Stabilize the patient -
Tx

Back 116

Airway
Breathing
Circulation

Front 117

Coma -
Tx
Reverse the reversible -

Back 117

coma cocktail
O2
ID and tx underlying cause
Prevent further damage

Front 118

Broca's Aphasia -
What is it
What part of brain affected

Back 118

D/o of language production
motor
broken speech
comprehension is intact
expressive or
nonfluent aphasia
post. inferior frontal gyrus

Front 119

Broca's Aphasia -
Features

Back 119

Repetition is impaired

Front 120

Broca's Aphasia - why frustration -

Back 120

cuz aware

Front 121

Broca's Aphasia associated with -

Back 121

arm and face hemiparesis
hemisensory loss
apraxis of oral muscles

Front 122

Broca's Aphasia often secondary to

Back 122

left superior MCA stroke

Front 123

Broca's Aphasia -
Tx

Back 123

Speech therapy
tx underlying condition
wide range of outcomes
intermediate prognosis

Front 124

Wernicke's Aphasia -
What is it

Back 124

D/o of language comprehension
nonsensical production
Wernicke's is wordy
left post. superior temporal
receptive or fluent aphasia

Front 125

Wernicke's Aphasia -
Features

Back 125

Neologisms
word substitutions
unaware - no comprehension
secondary to
left inf./post MCA stroke

Front 126

Wernicke's Aphasia -
Tx

Back 126

Speech therapy
tx underlying condition
poorer prognosis than Broca's

Front 127

Brain Neoplasms -
Mets vs. Primary

Back 127

Benign usually > 65 y/o

Front 128

Brain Neoplasms -
Mets Metas -
Lots of Bad Stuff Kills Glia

Back 128

Metas -
Lots of Bad Stuff Kills Glia
Lung Breast Skin Kidney GI

Front 129

Brain Neoplasms -
Mets ?? Primary

Back 129

metas > primary
supratentorial
at junction of gray and
white matter

Front 130

Primary (1o) -MC primary in adults -

Back 130

glioblastoma and meningioma
most 1o are supratentorial

Front 131

MC primary in kids -

Back 131

medulloblastoma & astrocytoma
most 1o are infratentorial

Front 132

Brain Neoplas ms -
Dx CT with????

Back 132

CT with contrast

Front 133

Brain Neoplas ms -
Dx MRI with

Back 133

gadolinium

Front 134

Brain Neoplas ms -
Dx CT-guided

Back 134

Bx

Front 135

Brain Neoplas ms -
Dx

Back 135

Bx during surgical tumor
debulking

Front 136

Brain Neoplasms -
General Principles of Tx

Back 136

Resection (if possible)
radiation
chemo
palliative tx
corticosteroids -
reduce vasogenic edema
type of therapy depends on -
type of tumor
histology
progression
site

Front 137

Brain Neoplasms:
Glioblastoma -
Characteristics and
Presentation

Back 137

Grade IV astrocytoma
MC primary brain tumor
prognosis grave
< 1 year to live
can cross corpus callosum
progresses fast
headache
ICP

Front 138

Brain Neoplasms:
Glioblastoma -
Tx

Back 138

Surgical resection
radiation and chemo
have variable results

Front 139

2nd MC primary

Back 139

Meningioma -

Front 140

Meningioma -Characteristics and
Presentation

Back 140

often incites osteoblastic
reaction in overlying
cranial bones
incidence inc. with age

Front 141

Meningioma - orig from

Back 141

dura or arachnoid

Front 142

Meningioma -prognosis

Back 142

good prognosis

Front 143

Brain Neoplasms:
Meningioma -
Tx

Back 143

Surgical resection
radiation for unresectable

Front 144

Brain Neoplasms:
Acoustic Neuroma (Cihannoma)

Back 144

Derived from cihan cells
bilat cihannoma in NF2

Front 145

Acoustic Neuroma (Cihannoma)Characteristics and
Presentation

Back 145

Ipsilateral hearing loss
tinnitus
vertigo
signs of cerebellar dysfunction
facial weakness
facial sensory loss

Front 146

Acoustic Neuroma (Cihannoma)

Back 146

Surgical removal

Front 147

Brain Neoplasms:
Astrocytoma -Sibelcanoma
Characteristics and
Presentation

Back 147

Grades 1 - pilocytic,
mainly kids
grade 2 - diffuse
grade 3 - anaplastic
grade 4 - glioblastoma multif

Front 148

Sibelcanoma
Characteristics and
Presentation

Back 148

headache
inc. ICP
can cause unilat paralysis in
CN 5-7 & CN10

Front 149

Sibelcanoma Tx

Back 149

Resection if possible
radiation

Front 150

Brain Neoplasms:
Medulloblastoma - sedanoma
locations

Back 150

arises from cerebellum
and 4th ventricle
can compress 4th ventricle
may seed subarachnoid space
inc. ICP

Front 151

sedanoma headache time

Back 151

morning headaches

Front 152

sedanoma malignancy

Back 152

Highly malignant

Front 153

sedanoma tx

Back 153

Surgical resection
coupled with
radiation and chemo

Front 154

Brain Neoplasms:
Ependymoma -zaranoma
Characteristics and
Presentation

Back 154

Common in kids
arises from ventricles
and spinal cord
commonly found in 4th ventricle
can cause hydrocephalus

Front 155

-zaranoma

Back 155

Surgical resection
radiation

Front 156

Neurofibromatoses -
What are they

Back 156

NF1 - HOUSE MD
von Recklinghausen
AD
chromosome 17

NF2
chromosome 22

Front 157

HOUSE MD

Back 157

2 or more of signs

Front 158

HOUSE MD skin findingds

Back 158

neurofibromas (2)

Front 159

HOUSE MD skin findingds

Back 159

cafe-au-lait spots (6)

Front 160

HOUSE MD axillary or inguinal

Back 160

freckling -
axillary or inguinal

Front 161

HOUSE MD eye findings

Back 161

optic glioma

Front 162

HOUSE MD eye findings

Back 162

lisch nodules (2)

Front 163

HOUSE MD eye findings

Back 163

osseous abnorm
1st degree relative with NF1

Front 164

NF2 - Dr Coddy

Back 164

bilat acoustic neuromas

Front 165

Dr Coddy or

Back 165

1st deg. relative with NF2
and unilat acoustic neuroma

Front 166

Dr Coddy or

Back 166

1st deg. relative with NF2
and neurofibroma,
meningioma,
glioma

Front 167

Dr Coddy or

Back 167

schwannoma

Front 168

HOuse md dx

Back 168

MRI -
brain
brain stem
spine
derm exam
ophthal exam
family Hx
hearing test

Front 169

HOuse md

Back 169

No cure
tx symptoms
surgical removal for
acoustic neuromas

Front 170

Tuberous Sclerosis - Kucuk zenci eleman neurologic

Back 170

Seizures - start as infant
mental retardation

Front 171

Kucuk zenci eleman

Back 171

skin and eye lesions

Front 172

Kucuk zenci eleman

Back 172

small benign tumors -
brain
face
eyes
kidney
other organs
very variable clinical course

Front 173

Kucuk zenci eleman

Back 173

AD
chromosome 9

Front 174

Kucuk zenci velet as an infant
Hx/PE

Back 174

Infantile spasms

Front 175

Kucuk zenci velet skin

Back 175

ashleaf lesions -
hypopigmentation
trunk and extremities

Front 176

Kucuk zenci velet saCRUM

Back 176

shagreen patch - lumbosacral

Front 177

Kucuk zenci velet - nose, cheeks

Back 177

sebac. adenoma

Front 178

Kucuk zenci velet tumors

Back 178

mulberry tumors

Front 179

Kucuk zenci velet tumors

Back 179

phakomas

Front 180

phakomas

Back 180

benign growths seen as white patches on the retina

Front 181

mulberry tumors

Back 181

Nodular astrocytoma of the retina on or about the optic nerve head.

Front 182

Kucuk zenci velet dX CT -

Back 182

calcified tubers
periventricular areas
can => astrocytomas (rare)

Front 183

Kucuk zenci velet Wood's UV lamp -

Back 183

skin lesions

Front 184

Kucuk zenci velet DX

Back 184

EKG
renal US

Front 185

Kucuk zenci velet TX FOR SEIZURE

Back 185

Levent kirca or Araklamaci gazeteci

Front 186

Kucuk zenci velet TX

Back 186

inc. ICP -
may indicate
a tuber obstructing
Foramen of Murro
surgery

Front 187

Kucuk zenci velet TX

Back 187

EKG

Front 188

LEVENT KIRCA

Back 188

Clonazepam

Front 189

Araklamaci gazeteci

Back 189

valproic acid

Front 190

Von Hippel-Lindau -
genetics

Back 190

Dominant teyze
deletion of VHL gene on ch CIRA

Front 191

Von Hippel-Lindau - hemangioblastoma -

Back 191

cerebellum
medulla

Front 192

Von Hippel-Lindau - Kidney

Back 192

retinal angioma
RCC
pheochromocytoma

Front 193

Von Hippel-Lindau -
Hx/PE

Back 193

Headache
N/V
cerebellar Sxs

Front 194

Von Hippel-Lindau -
Hx/PE

Back 194

retinal angiomas -

Front 195

retinal angiomas - place
complication

Back 195

usu. periphery
can => retinal detachment

Front 196

Von Hippel-Lindau -
Dx

Back 196

CT - head, abdo
MRI -
post. fossa emphasis
serpentine signal voids
angiography - vascularity
CBC - polycythemia
VMA levels in urine
ophthal US

Front 197

Von Hippel-Lindau -
Tx

Back 197

Surgical resection
or
radiation

Front 198

Osler-Weber-Rendu BArbara-genetics

Back 198

AD

Front 199

BARBARA -also called -

Back 199

Hereditary Hemorrhagic
Telangiectasia (HHT)

Front 200

BARBARA telangiectasia and AVM
in

Back 200

lungs, GI, brain
recurrent epistaxis

Front 201

BARBARA Hx/PE

Back 201

Recurrent epistaxis
painless bleeding in bowel

Front 202

BARBARA hepatic AV fistula -

Back 202

(hepatomegaly
RUQ pain
pulsatile mass
palpable thrill
audible bruit
high-output CHF
liver failure)

Front 203

BARBARA hep. enceph -

Back 203

portosys shunt
neuro complications

Front 204

BARBARA rt-to-left shunt -

Back 204

(cyanosis
clubbing
hypoxemia
2ndary polycythemia
exertional dyspnea)

Front 205

BARBARA tx

Back 205

Iron
folate
symptomatic tx of epistaxis
embolization,
surgical excision
or ligation of AV fistulas

Front 206

BARBARA???- contraindicated

Back 206

ASA

Front 207

Closed-Angle Glaucoma -
Hasan amca

Back 207

Med emergency
usu older pts. and Asians

Front 208

Hasan amca mechanism

Back 208

iris root plugs opening of
trabecular meshwork
acutely

Front 209

Hasan amca causes

Back 209

pupillary dilation
anterior uveitis
dislocation of lens

Front 210

Hasan amca Hx/PE

Back 210

Intraocular pressure inc.
very fast
extreme periocular pain
acute red eye
blurred vision

Front 211

Hasan amca Dx Best diagnostic test -

Back 211

tonometry

Front 212

Hasan amca Tx

Back 212

acetazolamide
pilocarpine - when P drops

Front 213

Hasan amca - curative

Back 213

laser iridotomy

Front 214

Most common form
Glaucoma -

Back 214

Open-Angle Glaucoma mustesar kemal

Front 215

Open-Angle Glaucoma bi unilateral??

Back 215

almost always bilateral

Front 216

mustesar kemal risk factors -

Back 216

> 40 y/o
Black
diabetic
myopic
family Hx
diseased trabecular meshwork
obstructs proper drainage

Front 217

mustesar kemal cause of vision lose

Back 217

=> intraoc P inc. gradually
progressive vision loss

Front 218

mustesar kemal vision loss -

Back 218

moves periph to central

Front 219

mustesar kemal at end

Back 219

=> blindness

Front 220

mustesar kemal
Hx/PE

Back 220

Asymp initially

Front 221

mustesar kemal suspect if pt. -

Back 221

> 35 y/o
freq. lens changes
mild headaches
vision disturbances
impaired adaptation to dark

Front 222

mustesar kemal earliest defect -

Back 222

periph nasal fields
cupping of optic disk

Front 223

mustesar kemal dx

Back 223

Tonometry
ophthalmic exam of optic n.
central field testing
eval on long-term basis
can be hard to Dx until
advanced stages

Front 224

Mustesar Kemal tx Prevention

Back 224

> 40 y/o - exam every 3-5 yrs
inc. risk factor - annually

Front 225

Mustesar Kemal tx

Back 225

timolol, betaxolol
pilocarpine
acetazolamide

Front 226

Mustesar Kemal tx

Back 226

laser trabeculoplasty -
if meds fail

Front 227

MCC of permanent bilat
vision loss in elderly

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Macular Degeneration -
What is it

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Macular Degeneration -
What is it vision loss -

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central do not lose periph

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Macular Degeneration -
difference between atrophic and exudative form

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atrophic - gradual loss
exudative -
faster
damage more severe

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Macular Degeneration -
Hx/PE

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painless loss of
central vision

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Macular Degeneration -atrophic -

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irreg pigmentation of
macular region

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Macular Degeneration -exudative -

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hyperpigmentation
pimple-like elevation of
macula - from hemorrhage

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Macular Degeneration -Laser photocoagulation -

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may delay loss of central
vision in exudative

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Retinal Artery Occlusion -
What is it

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From emboli or thrombi
sudden
painless
unilat blindness

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Retinal Artery Occlusion -pupil

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pupil accommodates but reacts
sluggishly to direct light

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Retinal Artery Occlusion - retina

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cherry-red spot on fovea
artery may look bloodless
retinal edema

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Retinal Artery Occlusion -?????within
8 hrs of onset of Sx

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Thrombolysis within
8 hrs of onset of Sx

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Retinal Artery Occlusion -dec. intraoc P -

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drain ant. chamber

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Retinal Artery Occlusion -

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IV acetazolamide

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Retinal Vein Occlusion - eye exam

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Sudden
painless
retinal hemorrhages
cotton wool spots
edema of fundus
elderly

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Retinal Vein Occlusion -MCC

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- HTN
can => macular dis., glaucoma

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Retinal Vein Occlusion -Tx

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Laser photocoagulation

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Inc. ICP -
Causes Blood -

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EDH, SDH, SAH, ICH
spontaneous or traumatic

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Inc. ICP -
Causes due to CSF -

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hydrocephalus
idiopathic intracranial HTN

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Inc. ICP -
Causes due to brain mass -

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tumor

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Inc. ICP -
Causes due to trauma -

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cerebral contusions

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Inc. ICP -
Causes due to edema -

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trauma
tumors

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Inc. ICP -Signs in approx. order
of appearance

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N/V and headache
altered mental status

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Inc. ICP -Signs in approx. order
of appearance than

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in kids - bulging fontanelles

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Inc. ICP -Signs in approx. order
of appearance than

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papilledema

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Inc. ICP -Signs in approx. order
of appearance than

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CN palsies - esp. CN6

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Inc. ICP -Signs in approx. order
of appearance than

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Cushing's Triad -
(HTN
brady
irreg breathing)

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Inc. ICP -Signs in approx. order
of appearance than

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endstage -
cerebral herniation

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Inc. ICP -
Tx -
in order

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Make sure BP and resp. good

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Inc. ICP -
Tx -
in order

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sedation

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Inc. ICP -
Tx -
in order

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elevate head of bed

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Inc. ICP -
Tx -
in order

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IV mannitol

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Inc. ICP -
Tx -
in order

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hyperventilate to CO2 30-35

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Inc. ICP -
Tx -
in order

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ventriculostomy

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Inc. ICP -
Tx -
in order

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surgery -
removal of hematoma
decompressive craniectomy

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Herniation -
What is it
Types
Dx

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Endpoint of untreated masses
or inc. ICP
specific signs and Sxs
depends on type of hernia
and mass lesion

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uncal herniation -

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CN3 compression:
ipsilat dilated pupil
midbrain compression:
ipsilat hemiplegia

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tonsillar herniation -

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resp. compromise

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Dx -

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CT without contrast -
r/o mass lesion or hemorrhage

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Guillain-Barre - La Ispanyol
What is it

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Acute
rapidly progressive
acq. demyelinating autoimmune

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Ispanyol

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d/o of periph nerves

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Ispanyol

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recent C. jejuni infection
viral infection
recent vaccination

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Ispanyol process and involvement

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Rapidly progressive
ascending paralysis
involves trunk, diaph and CN
autonomic Sxs
areflexia

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Ispanyol dx Diffuse demyelination on -

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EMG & nerve conduction studies

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Ispanyol csf

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albuminocytologic dissociation
CSF prot. > 55 mg/dL

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Ispanyol tx

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ICU -
risk of respiratory failure
plasmapheresis or IVIG
aggressive rehab

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MS -
What is it

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Acq. demyelinating dis.
may have T cell-mediated
autoimmune pathogenesis
environmental and genetic

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MS female-to-male

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2:1

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MS age geography

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20-40 y/o
inc. prev. with gtr distance
from equator

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MS risk -

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related to where lived
the 1st 15 yrs. of life

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MS subtypes -

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benign
relapsing/remitting
2o progressive
chronic progressive

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MS -
Hx/PE

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Mult. neuro complaints

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MS -
Hx/PE

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sep. in time and space
can't be explained by a
single lesion

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MS -
Hx/PE

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limb weakness

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MS -
Hx/PE

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optic neuritis
paresthesias
diplopia
internuclear ophthalmoplegia

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MS -
Hx/PE

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urinary retention

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MS -
Hx/PE

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vertigo

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MS -
Hx/PE

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Sxs wax & wane or progress

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MS -
Hx/PE exacerbations -

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stress
infections
heat
trauma
vigorous activity

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MS -
Dx describe MRI finding

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Multiple, asymmetric periven-
tricular lesions in white mtr

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MS -
Dx corpus callosum lesions -

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pathognomonic

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MS -
Dx active lesions enhance with

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Gado on MRI

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MS -
Dx CSF

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inc. CSF IgG
oligoclonal bands

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MS -
Tx Acute -

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steroids

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MS -
Tx treat Sxs - spasticity:

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baclofen or zanaflex

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MS -
Tx treat Sxs - pain:

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phenytoin

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MS -
Tx treat Sxs - fatigue:

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amantadine or provigil

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MS -
Tx treat Sxs -

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depression
avoid hot climates

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MS -
Tx prophylaxis:

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immunomodulators

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MS -immunomodulators

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reduce no. of attacks, disability

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MS Avonex -

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once wkly IM

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MS Betaseron

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- every other day subq

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MS Copaxone

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- daily subq