Mfy Neurology For Usmle Step2 Ii

Front 1

Stroke -
Types 2

Back 1

Ischemic - 80%
emboli
thrombi
systemic hypoperfusion

hemorrhagic

Front 2

Stroke -
Risk Factors

Back 2

Age
male
race
HTN
diabetes
obesity
smoking
hypercholesterolemia
AF
carotid stenosis
coke
alcohol
IV drug user

Front 3

Stoke -
Aphasia

Back 3

Aphasia

Front 4

Stoke -
neglect

Back 4

MCA

Front 5

Stoke -
gaze preference

Back 5

MCA

Front 6

Stoke -
homonymous hemianopsia

Back 6

MCA

Front 7

Stoke -
contralateral hemiparesis -

Back 7

MCA

Front 8

Stoke -
arm/face > leg

Back 8

MCA

Front 9

Stoke -
Amnesia

Back 9

ACA

Front 10

Stoke -
personality changes

Back 10

ACA

Front 11

foot drop

Back 11

ACA

Front 12

gait dysfunction

Back 12

ACA

Front 13

cognitive changes

Back 13

ACA

Front 14

contralateral hemiparesis -

Back 14

ACA

Front 15

leg > arm/face

Back 15

ACA

Front 16

Homonymous hemianopia

Back 16

PCA

Front 17

memory deficits

Back 17

PCA

Front 18

dyslexia/alexia

Back 18

PCA

Front 19

Coma

Back 19

Basilar

Front 20

CN palsies

Back 20

Basilar

Front 21

apnea

Back 21

Basilar

Front 22

visual Sxs

Back 22

Basilar

Front 23

drop attacks

Back 23

Basilar

Front 24

dysphagia

Back 24

Basilar

Front 25

Unilat pure motor or sensory

Back 25

Lacunar

Front 26

dysarthria -

Back 26

Lacunar

Front 27

clumsy hand syndrome

Back 27

Lacunar

Front 28

ataxic hemiparesis

Back 28

Lacunar

Front 29

Transient neuro deficits
last < 24 hours

Back 29

TIA

Front 30

TIA
most last

Back 30

most last < 1 hour

Front 31

Stoke -
Dx CT without contrast -

Back 31

ischemic vs. hemorrhagic

Front 32

Stoke
Dx

Back 32

MRI
EKG
echocardiogram

Front 33

Stoke
Dx

Back 33

vascular studies -
carotid US
MRA

Front 34

Stoke
Dx

Back 34

transcranial doppler or MRA
screen for hypercoagulability
PE

Front 35

Stoke -
Tx* Vigilance for signs of -

Back 35

brain swelling
inc. ICP
herniation

Front 36

Stoke -
Tx ischemic stroke
if admin within 3 hrs.
of onset of Sxs

Back 36

* tPA -

Front 37

Stoke -
Tx ischemic stroke presenting
within 48 hours

Back 37

* ASA -

Front 38

Stoke -
Tx * no hypo's

Back 38

* no hypotension, hypoxemia,
hypoglycemia

Front 39

Stoke -
Tx for periphery

Back 39

* tx aspiration pneumonia,
UTI or DVT

Front 40

Stoke -
Preventive and Long-Term
antiagregan

Back 40

* ASA, clopidogrel or
dipyridamole/ASA

Front 41

Stoke -
Preventive and Long-Term vascular

Back 41

* carotid endarterectomy

Front 42

Stoke -
Preventive and Long-Term anticoags

Back 42

* anticoags

Front 43

* management of

Back 43

HTN, DM and
hypercholesterolemia

Front 44

Carpal Tunnel Syndrome -
What is it

Back 44

Median n. compression where
passes thru carpal tunnel

Front 45

Carpal Tunnel Syndrome -

Risk factors

Back 45

women 30-55

Front 46

CTS
Risk factors

Back 46

repetitive use injury
pregnancy
DM

Front 47

CTS Risk factors

Back 47

hypothyroidism
acromegaly
RA
obesity

Front 48

CTS
pain location and funcionality

Back 48

Wrist pain
numbness & tingling of 3 1/2
weak grip
dec. thumb opposition

Front 49

CTS when aches

Back 49

thenar atrophy
nocturnal pain & paresthesias

Front 50

CTS Signs ??how worse

Back 50

Sxs may awaken pt. at night
relieved by shaking wrist

Front 51

CTS -
Workup Tinel's sign -

Back 51

tap
tingle

Front 52

CTS - Phalen's sign -

Back 52

Phalen's sign -
ph-lex (flex)
paresthesias

Front 53

CTS to confirm

Back 53

EMG - to confirm
NCV - to confirm
eval for risk factors

Front 54

Carpal Tunnel Syndrome -
Tx

Back 54

Neutral wrist splint
modify activity
create ergonomic work envi

Front 55

CTS Tx medications

Back 55

NSAIDs
corticosteroids -
direct injection

Front 56

CTS Tx surgery

Back 56

if Sxs persist -
carpal tunnel release

Front 57

Myasthenia Gravis -
What is it

Back 57

Autoimmune
Ab that bind to postsynaptic
Ach receptors (nicotinic)
block receptors
lose receptors

Front 58

MG age

Back 58

young adult women

Front 59

MG can be associated with -

Back 59

thymoma
thyrotoxicosis

Front 60

Muscle weakness inc. in
periods of activity
dec. after rest

Back 60

MG

Front 61

Sx come and go
onset can be sudden
fluctuating fatigable ptosis

Back 61

MG

Front 62

MG eye mouth2

Back 62

diplopia (double vision)
dysphagia (swallowing)
dysarthria (speech)

Front 63

Sxs worsen throughout day

Back 63

MG

Front 64

myasthenic crisis -

Back 64

so severe,
resp. failure and aspiration
secondary to weakness

Front 65

myasthenic crisis -often secondary to

Back 65

often secondary to infection
(resp. muscles compromised)

Front 66

Myasthenia Gravis -
Hx/PE ocular myasthenia -

Back 66

common variant
if doesn't spread in 2-3 yrs,
probably won't

Front 67

Myasthenia Gravis -
diagnostic testr

Back 67

Edrophonium (tensilon test) -

Front 68

Myasthenia Gravis -
Dx

Back 68

abnormal single-fiber EMG
dec. response to
repetitive n. stimulation

Front 69

Myasthenia Gravis - if thymoma

Back 69

chest CT - eval for thymoma
antistriatal ab if thymoma

Front 70

Myasthenia Gravis -
Tx

Back 70

* Neostigmine (treat Sx)

Front 71

* pyridostigmine (treat Sx)

Back 71

* prednisone

Front 72

* plasmapheresis or IVIG -
temp relief (wks) if severe

Back 72

* thymoma resection

Front 73

Amyotrophic Lat. Sclerosis -
What is it

Back 73

Progressive neurodegen. dis
unknown etiology

Front 74

ALS which nerves

Back 74

degeneration of motor neurons
UMN and LMN degenerate
=> resp. failure and death

Front 75

Amyotrophic Lat. Sclerosis -
Hx/PE

Back 75

Slowly progressive weakness
may have fasciculations init
UMN and LMN

Front 76

Amyotrophic Lat. Sclerosis -
Dx

Back 76

Clinical presentation
EMG and n. conduction studies

Front 77

ALS CT/MRI -

Back 77

cervical spine
check for lesions

Front 78

ALS r/o systemic causes -

Back 78

CBC TSH SPEP UPEP
Ca2+ PTH PFTs

Front 79

ALS urine for heavy metal -

Back 79

(if h/o exposure)

Front 80

Amyotrophic Lat. Sclerosis -
Tx

Back 80

Supportive
pt. education
pulmonary specialist

Front 81

ALS medication

Back 81

riluzole

Front 82

Thiamine (B1) Deficiency -
What are Signs/Sxs

Back 82

Wernicke's

Front 83

Wernicke's

Back 83

inadeq intake or absorption
excessive alcohol interferes
with GI absorption
and liver storage

Front 84

Wernicke's acute onset -

Back 84

confusion

Front 85

Wernicke's opthalmoplegia -

Back 85

nystagmus
lat. rectus palsy
conjugate gaze palsy
abnormal pupils

Front 86

Wernicke's ataxia -

Back 86

vestibular dysfunction
cerebellar dysfunction

Front 87

Wernicke's pts

Back 87

Alcoholics
dialysis
hyperemesis
starvation

Front 88

Wernicke's pts

Back 88

cancer
AIDS
can be triggered by large-dose
glucose admin if deficient

Front 89

Wernicke's tx

Back 89

Reversible almost immediately
with thiamine admin

Front 90

Korsakoff's Psychosis -
What is it

Back 90

Late complication of
untreated pts. with Wernicke's

Front 91

KP can be triggered by

Back 91

severe or repeated DTs
can be triggered by SAH and
thalamic injuries

Front 92

KP ????? memory affected

Back 92

immediate memory affected
confabulation

Front 93

Korsakoff's Psychosis -
Prognosis good

Back 93

-
head injury and SAH
irreversible - others

Front 94

B12 deficiency -
What are Signs/Sxs

Back 94

Subacute combined degen

Front 95

B12 deficiency -
Pts.

Back 95

Pts with pernicious anemia

Front 96

B12 deficiency -
Tx

Back 96

B12 injections or
large oral doses

Front 97

Folate Deficiency -
What are Signs/Sxs

Back 97

Irritability
glossitis
diarrhea
depression
neural tube defects

Front 98

Folate Deficiency -

Back 98

glossitis

Front 99

Folate Deficiency -
Pts

Back 99

Alcoholics - alcohol
interferes with absorption
Pts. with pernicious anemia

Front 100

Folate Deficiency -
prognosis

Back 100

Reversible if corrected early

Front 101

. Epilepsy -

Back 101

seizure d/o
2+ seizures not related
to reversible stressors

Front 102

. was seizure epileptic -

Back 102

Hx
inc. prolactin = epileptic

Front 103

seizure caused by -
. VITAMINS

Back 103

vascular
infection
trauma
autoimmune
metabolic
idiopathic
neoplasm
sychiatric (faking it)

Front 104

. anticonvulsant therapy
indicated?

Back 104

. anticonvulsant therapy
indicated?
1st seizure not treated
when underlying cause unknown

Front 105

Partial Seizures -
What are they

Back 105

Arise from focus
limited to one side
consciousness usually not lost
can progress to generalized
simple partial & complex part

Front 106

Partial Seizures -
Simple partial -

Back 106

consciousness not impaired

Front 107

Partial Seizures -motor -

Back 107

Jacksonian march

Front 108

They are unique in that they travel through the primary motor cortex in succession, affecting the corresponding muscles, often beginning with the fingers. This is felt as a tingling sensation.

Back 108

It then affects the hand and moves on to more proximal areas. Symptoms often associated with a Jacksonian seizure are sudden head and eye movements, tingling, numbness, smacking of the lips, and sudden muscle contractions. Most of the time any one of these actions can be seen as normal movements, without being associated with the seizure occurring

Front 109

Partial Seizures -
sensory

Back 109

- parietal

Front 110

Partial Seizures -
autonomic

Back 110

- BP, HR, PVR

Front 111

Partial Seizures -psychic -

Back 111

fear, deja vu

Front 112

Partial Seizures -psychic -

Back 112

fear, deja vu

Front 113

Partial Seizures postictally -

Back 113

Todd's paralysis is focal weakness in a part of the body after a seizure.
resolves in 1-2 days

Front 114

Partial Seizures Complex partial -

Back 114

consciousness impaired
temporal lobe
auditory or visual hallucinat
deja vu
automatisms

Front 115

Partial Seizures postictal -

Back 115

confusion
amnesia

Front 116

Partial Seizures Workup

Back 116

EEG

Front 117

Partial Seizures r/o systemic causes -

Back 117

CBC
electrolytes
Ca2+
fasting glucose
LFTs
tox screen
RPR
renal panel
ESR

Front 118

Partial Seizures r/o mass -

Back 118

MRI or CT with contrast

Front 119

Partial Seizures tx

Back 119

Tx underlying cause

Front 120

Partial Seizures -
Tx recurrent partial -

Back 120

phenytoin
oxcarbazepine
tegretol
phenobarbital
valproic acid

Front 121

Partial Seizures -
Tx kids -

Back 121

phenobarbital

Front 122

Partial Seizures -
Tx

Back 122

intractable temporal lobe -
WADA testing

Front 123

Partial Seizures -
Tx

Back 123

ant. temporal lobectomy

Front 124

Generalized Seizures -
What are they

Back 124

Begin diffusely throughout
both sides

Front 125

Generalized Seizures - consciousness

Back 125

consciousness always lost
postictal confusion

Front 126

most common types -

Back 126

tonic-clonic (grand mal)
absence (petit mal)

Front 127

Tonic-Clonic Seizures -

Back 127

Start suddenly
with tonic extension of
back and extremities
rep. symm. clonic movements

Front 128

Tonic-Clonic Seizures -

Back 128

incontinence
tongue biting
may look cyanotic
consciousness slowly regained

Front 129

Tonic-Clonic Seizures -may complain of -

Back 129

muscle ache
headache

Front 130

Tonic-Clonic Seizures -
Tx

Back 130

Tx underlying cause

Front 131

Tonic-Clonic Seizures -
Tx idiopathic -

Back 131

Araklamaci gazeteci - 1st line
lama - adjunctive
topiramate - adjunctive

Front 132

Tonic-Clonic Seizures -
Tx symptomatic -

Back 132

same therapy as partial sz.

Front 133

Absence (Petit Mal) Seizures-
What are they

Back 133

Begin in childhood
subside before adulthood
often familial

Front 134

Absence (Petit Mal) Seizures-
how often

Back 134

Brief, often unnoticeable
episodes of
impaired consciousness
lasts 5-10 seconds
have 100's of times/day
eye flutters or lips smack

Front 135

amnestic ???

Back 135

amnestic during and
immediately after

Front 136

can be precipitated by

Back 136

hyperventilation

Front 137

Absence (Petit Mal) Seizures-
Evaluation EEG -

Back 137

3 Hz per sec. spike
& wave discharges

Front 138

Absence (Petit Mal) Seizures-
Tx

Back 138

eto- 1st line
araklamaci gazeteci
zonisamide

Front 139

(West Syndrome) -

Back 139

Infantile Spasms

Front 140

Infantile Spasms
(West Syndrome) -

Back 140

. infantile spasms
(generalized seizures)
symmetric
tonic

Front 141

Infantile Spasms
(West Syndrome) -

Back 141

5-10 at a time while drowsy
or upon awakening
. abnorm interictal EEG
. arrest of psychomotor dev.

Front 142

Infantile Spasms Tx -

Back 142

ACTH
prednisone
clonazepam
valproic acid

Front 143

Status Epilepticus -

Back 143

Brain in persist. state of Sz
1 cont. seizure or recurrent
w/o regaining cons. > 30 min.
med emergency - 20% mortality

Front 144

Status Epilepticus -common causes -

Back 144

anticonv. withdrawal/noncomp
anoxic brain injury
alcohol withdrawal
metab disturb (hypoNa+)
trauma
infection

Front 145

Status Epilepticus -usual cause -

Back 145

subtherapeutic or
noncompliance

Front 146

Status Epilepticus -
Evaluation first

Back 146

Airway, breathing, circulation

Front 147

Status Epilepticus -
Evaluation labs -

Back 147

electrolytes
anticonvulsants

Front 148

Status Epilepticus -
Evaluation

Back 148

get Hx
look for etiology if
no prior Hx
(tumor, encephalitis, SAH)

Front 149

Evaluation of SE

Back 149

(EEG, CT only when stable)

Front 150

west syndrome

Back 150

at age of onset
starts at 3-12 months
usu male
MR

Front 151

Status Epilepticus -
Tx

Back 151

Diazepam or lorazepam

Front 152

Status Epilepticus -
Tx if continues -

Back 152

phenytoin or fosphenytoin

Front 153

Status Epilepticus -
Tx if continues -

Back 153

phenobarbital

Front 154

Status Epilepticus -
Txif continues -

Back 154

midazalom or propoful

Front 155

Headache -
Things to think about
(Evaluation)

Back 155

Headache new or old
characteristics
any associated Sxs
any neurological Sxs
SAH suspected?

Front 156

Migraine Headache - More commonly affects ????
and those with ???? Hx
????? & ???? abnorm

Back 156

More commonly affects women
and those with family Hx
vascular & 5HT abnorm

Front 157

Migraine Headache -triggers -

Back 157

menses
OCP
chocolate
fasting
stress
bright lights

Front 158

Migraine Headache -
Hx/PE
Throbbing > ???
usually lasts < ???
GIS symptoms
????phobia
sensitive to ???

Back 158

Throbbing > 2 hrs
usually lasts < 24 hrs
n/v
photophobia
sensitive to noise

Front 159

"classic" migraine -

Back 159

visual aura precedes
unilat

Front 160

"common" migraine -

Back 160

80%
can be b/l, periorbital

Front 161

Migraine Headache -
Dx

Back 161

if have focal neuro deficits-
CT or MRI

Front 162

Migraine Headache -
Sxs acute in onset -

Back 162

r/o meningitis or SAH

Front 163

Migraine Headache -
Tx

Back 163

Avoid known triggers
aspirin/NSAIDs
sumatriptan

Front 164

Migraine triggers

Back 164

aspirin/NSAIDs
sumatriptan

Front 165

Migraine prophylaxis -

Back 165

beta-blockers
TCAs
Ca2+ channel blockers
valproic acid

Front 166

Cluster Headache -
What is it

Back 166

Men
~ 25 y/o - age of onset

Front 167

Cluster Headache -
location
duration

Back 167

Unilat, periorbital
30 min. - 3 hrs.

Front 168

Cluster Headache -attacks in clusters -

Back 168

same part of head
same time of day
same time of year

Front 169

Cluster Headache - precipitators

Back 169

can be precip by alcohol or
vasodilators
ipsilat tearing of eye

Front 170

Cluster Headache -
Dx

Back 170

HX

Front 171

Cluster Headache -
Tx Acute therapy with

Back 171

high-flow O2
(100% nonrebreather O2)
sumatriptan
corticosteroids

Front 172

prophylaxis -

Back 172

Ca2+ channel blockers
valproic acid
methylsergide

Front 173

prophylaxis important -

Back 173

by the time abortive meds take
effect, has already resolved

Front 174

methylsergine (sansert) - careful??

Back 174

need drug holiday every several months to avoid risk of retroperitoneal fibrosis

Front 175

MC type diagnosed in adults
chronic

Back 175

Tension Headache -

Front 176

Tension Headache - describe

Back 176

Tight, bandlike pain
occipital and neck

Front 177

Tension Headache - exacerbated by -

Back 177

noise
bright lights
stress
fatigue

Front 178

Tension Headache - Dx

Back 178

Dx of exclusion

Front 179

Tension Headache -
Tx

Back 179

Avoid exacerbating factors
NSAIDs - 1st line

Front 180

Tension Headache -
prophylaxis -

Back 180

Ca2+ channel blockers
alpha blockers
TCAs

Front 181

Benign Paroxysmal

Back 181

Peripheral vertigo
otoliths dislodge from
usual position
migrate over time into
semicircular canals
abnorm fluid displacement
=> vertigo

Front 182

Benign Paroxysmal
Positional Vertigo -
Hx/PE

Back 182

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 dec. with repetitive tests
usu h/o recent trauma

Front 183

Benign Paroxysmal
Positional Vertigo -
Dx

Back 183

Nylen-Barany Maneuver
(Dix-Hallpike)

Front 184

Benign Paroxysmal
Positional Vertigo -
Tx

Back 184

Usually subsides spontan.
in wks to months
Epley Repositioning Maneuver

Front 185

Meniere's Disease
(Endolymphatic Hydrops) -
What is it

Back 185

Peripheral vertigo
from buildup of endolymphatic
fluid in inner ear

Front 186

Meniere's Disease

Back 186

= V and P change
risk factors -
head trauma
syphilis

Front 187

Meniere's Disease
(Endolymphatic Hydrops) -
Hx/PE

Back 187

Sudden attacks of vertigo
lasts up to 24 hours
attacks can last hrs to days
n/v
ear fullness
tinnitus
hearing loss
signif permanent hearing loss
can occur over period of yrs

Front 188

Meniere's Disease
(Endolymphatic Hydrops) -
Dx

Back 188

Audiometry -
low-freq. pure tone
hearing loss

Front 189

Meniere's Disease
(Endolymphatic Hydrops) -
Tx

Back 189

Low-salt diet
acetazolamide

Front 190

Meniere's Disease
(Endolymphatic Hydrops) -
Tx acute -

Back 190

antihistamines
antiemetics
benzos

Front 191

Meniere's Disease
(Endolymphatic Hydrops) -
Tx if refractory -

Back 191

surgical decompression

Front 192

Parkinsonism cause antiemetics

Back 192

(metoclopramide),

Front 193

Parkinsonism cause indole alkaloid antipsychotic and antihypertensive drug

Back 193

reserpine.

Front 194

Poisoning from 4.................................................... are also causes of Parkinsonism.

Back 194

MPTP, carbon monoxide, cyanide, and
manganese

Front 195

Patients who have
survived an episode of encephalitis can develop

Back 195

postencephalitic Parkinsonism.

Front 196

Parkinsonism + vertical gaze palsy

Back 196

= supranuclear palsy

Front 197

Parkinsonism + prominent ataxia

Back 197

= olivopontocerebellar atrophy

Front 198

Parkinsonism + prominent orthostatic hypotension

Back 198

= Shy-Drager syndrome

Front 199

Severe ................................. can cause a paucity of
spontaneous movement that can mimic Parkinsonism.

Back 199

depression

Front 200

111111111 can be mistaken
for the tremor of Parkinson disease, but the lack of other neurologic symptoms and a positive
22222222 of tremor and its amelioration with 3333333333 distinguish the two entities.

Back 200

1 Essential tremor
2family history
33alcohol

Front 201

11111 can present with ataxia and gait disturbances, which can
also be mistaken for Parkinson disease. The presence of 2222 and 333333
with 44444 on a CT scan of the head can help identify this disorder

Back 201

1A normal pressure hydrocephalus
2dementia
3urinary incontinence
4dilated ventricles

Front 202

medications available for the medical treatment of Parkinson disease indirecdy
increase the amount of dopamine available

Back 202

(COMT inhibitors, selegiline, amantadine),

Front 203

Direct-acting dopamine agonists such as ----------------can be used alone as initial
therapy or in combination with small doses of levodopa/carbidopa.

Back 203

pramipexole or ropinirole

Front 204

Two other dopamine
agonists are

Back 204

bromocriptine and pergolide.

Front 205

Bromocriptine and pergolide
are 111111 and can cause 222222

Back 205

1ergot derivatives
2cardiac toxicity.

Front 206

Anticholinergics such as benztropine and trihexyphenidyl are used in patientsyounger than 60 years old mosdy to relieve
tremor and rigidity. Avoid with 22222

Back 206

BPH and glaucoma.