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198 Cards in this Set
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- 3rd side (hint)
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Spinal Cord Lesion: fasciculations but also flaccid paralysis?
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ALS (Lou Gerhig)
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UMN (corticospinal) + LMN (ventral horn)
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Spinal Cord Lesion: impaired proprioception + pupils do not react to light
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Tabes Dorsalis (3 syphilis) - Aryglyl Robinson pupil
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Dorsal columns = + Romberg Test (either proprioception or vestibular - NOT cerebellar)
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Spinal Cord Lesion: bilateral loss of pain and temp below the lesion + hand weakness
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Syringomyelia
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"Cape-like" (ventral white commissure and ventral horn) - central cord cavity
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Spinal Cord Lesion: bilateral loss vibration sense + spastic paralysis of legs -> arms
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Vit B12 deficiency
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Dorsal columns + UMN (corticospinal tract)
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Spinal Cord Lesion: bilateral loss pain/temp below level of lesion + bilateral spastic paralysis below lesion + bilateral flaccid paralysis at level of lesion
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(Anterior) Spinal Artery Syndrome
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(spares dorsal columns) - ALL bilateral
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Spinal Cord Lesion: flaccid paralysis (ipsilateral At lesion)
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Poliomyelitis (or West Nile Virus)
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Ventral horn (LMN)
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Spinal Cord Lesion: ipsilateral flaccid paralysis at lesion, ipsilateral spastic paresis below lesion, ipsilateral loss vibration/proprioception below lesion, contralateral loss pain and temp below lesion (1-3 levels)
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Brown-Sequard syndrome
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Hemisection of spinal cord (all ipsilateral loss except for spinothalamic tract - pain and temp)
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Spinal Cord Lesion: Unilateral facial paralysis, deafness, tinnitus, nystagamus, N/V
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AICA syndrome
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Pons lesion - occulsion of facial, vestibular and cochlear nucleus (NO loss of motor or light touch)
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Spinal Cord Lesion: loss of pain and temp contralateral body and ipsilateral face + ataxia, past-pointing
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PICA (Wallenberg) Syndrome - post. inferior cerebellar artery
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Medulla and majority of the cerebellum
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Most likely cause of headache in a 40-year old woman with Frontal HA that is made worse by bending over?
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Sinus HA
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30 YO woman has severe HA in left temporal region along with visions of flashing lights and nausea?
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Migraine
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What medication is preferred for the actue treatment of migraines?
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Triptans (or ergots)
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What would be preferred anti-HTN in patient with chronic HTN and recurrent migraines?
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B-blocker (propanolol) or CCB
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What is considered the most effect medication in the treatment of trigeminal neuralgia?
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Carbamazepine
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What med should be given to close contacts of those with either meningococcal or HIB meningitis?
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Rifampin
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What are the four most common sequelae of bacterial meningitis in kids? (20% of time) and what do you give to prevent?
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1. Hearing loss (11%) 2. Chronic seizure disorder 3. MR 4. Spastic Paralysis
Tx: Steriods (Dexamethasone?) |
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What is the treatment for fungal meningitis?
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Amphotericin B (intrathecal)
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What is the meds used for TB meningitis?
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RIPE: rifampin, INH, pyramindine, ethambutol
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What cerebral artery infarct can cause aphasia?
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MCA (middle cerebral a.)
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What organism suspect in bacterial meningitis: gram + diplococci
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Strep. pneumoniae
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What organism suspect in bacterial meningitis: gram - diplococci
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Neiserria Menigiditis
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What organism suspect in bacterial meningitis: small pleomorphic gram - coocobacilli
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Hemophilus infulenzae
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What organism suspect in bacterial meningitis: gram + rods and coccobaciili
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Listeria pnuemoniae
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What are the 2 most common locations of aneurysms in Circle of Willis and what will it cause?
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1. Anterior communicating artery (bitemporal lower quadratopia) 2. Posterior communicating artery (CN 3 palsy - eyes look down and out)
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Contralateral hemiballismus (spastic arm movements): where is lesion?
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Subthalamic nucleus (can be a treatment for Parkinsons)
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Eyes look toward the lesion: where is lesion?
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frontal eye field (ACA)
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Eyes look away from the side of the lesion: where is lesion?
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PPFR
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Paralysis of upward gaze: where is lesion?
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Superior colliculi (Parinaud's syndrome - pinealoma or germinoma)
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Hemispatial neglect syndrome: where is lesion?
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Non-dominant (Right) parietal lobe
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Coma: where is lesion?
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Reticular activating system (RAS)
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Poor Repetition: where is lesion?
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Arcuate vesiculus (angular gyrus - Conduction aphasia)
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Poor comprehension: where is lesion?
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Wernickes "receptive" (posterior superior temporal perisylvian gyrus; inferior parietal lobe) - dominant (left)
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Poor vocal expression: where is lesion?
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Broca's "expressive" (inferior frontal gyrus) - dominant (left superior)
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Resting tremor: where is lesion?
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Basal gangila (think Parkinson's)
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Intention Tremor: where is lesion?
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Cerebellar hemispheres
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Hyperorality, hypersexuality, disinhibited behavior: where is lesion?
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Bilateral amygdala (temporal lobe) - Kluver Brucy Syndrome
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Personality changes: where is lesion?
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Frontal Lobe
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Dysarthria: where is lesion?
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Cerebellar Vermis
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Agraphia (inability to write) and aculculia
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Dominant (left) parietal lobe
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What is the anticoagulant of CHOICE in patient with: First TIA or stroke?
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Aspirin -> prevent reoccurrence
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What is the anticoagulant of CHOICE in patient with: TIA/stroke due to A. Fib?
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Warfarin (bridge with heparin first)
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What is the anticoagulant of CHOICE in patient with: TIA/stroke + coronary artery disease?
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Clopidogril (Plavix)
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What is the anticoagulant of CHOICE in patient with: repeat TIA/stroke while previously on aspirin?
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Copidogril or Aggrenox (ASA + dipyridamole)
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What are surgical indications for carotid endarterectomy?
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1. if symptomatic carotid a. stenosis 70-99%
2. asymptomatic with 80-99% stenosis + expected to live >5yrs and low complications 3. symptomatic and 50-69% stenosis is controversial? (men more likely) |
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What is the #1 risk factor for a stroke?
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HTN
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What is the most common artery involved in an Embolic stroke?
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MCA -> aphasia (left a.), neglect (right a.), contralateral hemiparesis (arm and face), homonymous hemianopsia, conjugate eye deviation toward infarct - think in A. fib
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What is the most common cause of thrombotic Ischemic stroke?
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Artherosclerosis of the extracranial vessels (internal/common carotid, basilar, vestibular a)
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Leg paresis (motor and sensory), personality changes, foot drop, gait dysfunction, cognitive changes: infarct where?
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Contralateral ACA
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"Locked-in syndrome", CN palsies, drop attacks, dysphagia, visual: infarct where?
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Basilar artery
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Definition of a TIA?
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acute focal neuro deficits lasting < 24 hours (most <2hrs and recurrent)
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When can you give tPA?
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Within 3 hours of sx onset of Ischemic stroke (better if sooner); 6 hr window if use local therapy with catheter directly into artery
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What are the 5 lacunar syndromes? Most due to what?
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HTN! (NO cortical signs - aphasia, neglect, apraxia, hemianopsia)
1. pure motor hemiparesis (most common) - weakness of face, arm, leg on contralateral 2. Ataxic hemiparesis - ipsilateral weakness and limb ataxia (gait deviation to affected side) 3. Pure sensory - numbness/parasthesias, tingling of face, arm, leg on one side (athetosis, ballistic) 4. Dysarthria-Clumsy hand syndrome: facial weakness, slurring of speech and slight weakness of one hand (no sensory deficit) 5. Mixed motor and sensory - one side of body |
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Where are the locations of the 5 lacunar strokes?
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Motor and Ataxic hemiparesis = posterior limb of internal capsule
Sensory = VPL (ventroposterolateral nucleus of thalamus) - tingling pain of thalamus Dysarthria-clumsy hand = basal pons |
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homonymous hemianopsia (with macular sparing), memory deficits, dyslexia/alexia: infart is where?
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PCA (post. cerebral artery)
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What is the treatment for a hemorrhagic stroke?
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1. Control ICP (hyperventilation (fastest), mannitol, elevate head of bed 30 deg) 2. maintain BP (systolic <150 if AAOx3) use CCB (Nimodipidine to prevent vasospasm) or Labatelol) surgical clipping or coiling -- AVOID nitroprusside and nitroglycerine (increase ICP)
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When can antiplatelet drugs be started after a hemorrhagic stroke?
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2 weeks if stable
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Which hemorrhage can have a midline shift
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Subdural -- (because epidural limited by sutures) but epidural may appear to cross brain midline
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What are the C/I of triptans/ergots?
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Preggo, prizamental angina, CAD, uncontrolled HTN, familial hemiplegic migraine
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What is treatment for tension HA? for cluster HA?
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tension - NSAIDS (ketorolac)
cluster - 100% O2 + triptan or ergot |
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What can be used as prophylaxis for migraines?
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CCB (Verapamil - first line b/c safe and well-tolerated), B-blocker (good if comorbid HTN), TCA (nortriptyline - less S/E), NSAIDS (naproxen - if menstrual migraine or comorbid osteoarthritis - BUT can cause chronic HA), Valproate, gabapentin
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Which HA: made worse by eating foods w/ tyramine (aged cheese/wine)?
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Migraine
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Which HA: Obese female with papilledema?
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Pseudotumor cerebi
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Which HA: Jaw muscle pain when chewing?
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Temporal arteritis
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Which HA: periorbital pain with ptosis and myosis?
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Cluster HA
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Which HA: Photophobia and/or phonophobia?
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Migraine
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Which HA: Bilateral frontal/occipital pressure?
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Tension
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Which HA: Lacrimation and/or rhinorrhea?
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Cluster
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Which HA: Elevated ESR?
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Temporal arteritis
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Which HA: "worst HA of my life"?
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Subarachnoid hemorrhage (#1 cause berry anyuersum, #2 AVM)
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Which HA: + extraocular muscle palsies?
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Cavernous Sinus Thrombosis
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Which HA: Scintillating scotomatas prior to HA?
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Migraine w/ Aura (C/I to take OCPs)
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Which HA: HA occurring either before or after orgasm?
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Post-coital selfthalga
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Which HA: responsive to 100% O2 supplementation?
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Cluster HA
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Which HA: trauma to head -> headache begins days after the event, persists for over a week and does not go away
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Subdural hemorrhage
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What are features of pseudotumor cerebi? What is the most worrisome sequelea? How do you Dx?
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young, obese female
daily HA (worse in am), pulsatile, N/V, retroocular pain worsened w/ eye movement Papilledema ** -> vision loss CT scan NORM (no tumor) but CSF pressure is elevated (>200 in non-obese, >250 in obese) when lying down |
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What is the treatment for pseudotumor cerebri?
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1. Weight Loss
2. Acetazolamide (1st line) 3. Stop Vit A, tetracyclines, corticosteriods - inciting agents 4. Surgery- optic nerve sheath decompression or lumboperitoneal shunting |
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What is the most common predisposing condition for an intracranial hemorrhage?
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HTN! (most common in the putamen)
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CT scan of head shows lacunar-shaped lesion?
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Subdural hemorrhage (blunt trauma of head in elderly on warfarin - bridging veins)
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A patient with DVT develops a stroke. What study would most likely identify the underlying etiology of the stroke?
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TEE (transesophageal echo) - patient probably has patent foramen ovale
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What is the treatment for normal pressure hydrocephalus?
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Ventriculoperitoneal shunt (wet, wobbly, wacky)
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What is the target BP in a patient with an Ischemic stroke? if want to give tPA?
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< 220/120 (don't be too aggressive)
<185/110 if give tPA |
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What is the difference between spastic cerebral palsy (CP) and dyskinetic CP?
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Spastic is more common (75%) and d/t damage of pyramidial tracts; Dyskinetic is choreoathetoid, dystonic movements (involuntary grimacing) (worsens during stress, stops in sleep) d/t extrapyramidial pathology. persistence of primitive reflexes and encephalopathy; a/w MR, epilepsy, speech, hearing and vision impairments
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What is the treatment for cerebral palsy?
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botulinum toxin (NM blocker), dantrolene (decrease Ca release at sarcoplasmic reticulum), Baclofen (muscle relaxant, benzos
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Lung cancer + muscle weakness?
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Lambert-Eaton syndrome (small cell lung cancer) improve with use (presynatic Ca defect)
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66 year old woman with forgetfulness and decreased bilateral PARIETAL lobe activity on PET scan?
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Alzheimer's disease
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Most sensitive test for MS? What is the treatment?
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MRI head/spinal cord -> demylination and plaques) - see multiple bilateral contrast-enhanced (white) in periventricular matter.
IFN-B (better) or Glatiramer acetate (decrease freq and severity) and steroids during actue attack |
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A 35 year old woman presents with ptosis and diplopia that worsens throughout the day? What is the underlying problem?
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Myasthenia Gravis - antibodies to Ach (postsynaptic) at the NMJ
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What is the preferred treatment of restless leg syndrome?
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Dopamine Agonists - (pramipexole or ropinirole or levodopa/carbidopa)
Gabapentin and benzos 2nd line |
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What medications are known for causing seizures?
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Bupropion (Wellbutrin), Busprione (GAD), Enflurane (anesthetic), Theophylline OD, B6 def (d/t INH - b/c B6 is GABA(inhibitory NT) so deficiency causes excitation)
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Which medication withdrawal is known for causing seizures?
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Alcohol, Benzo (short-term), Barbiturates, Anticonvulsants
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What is the DOC for: grand mal (tonic-clonic) seizure?
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Phenytoin, Valproate, Carbamazepine,
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What is the DOC for: partial seizure? in children?
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Phenytoin, Carbamazepine Lamotrigene
kids - phenobarbital |
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What is the DOC for: absence seizure
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Ethosuximide > Valproate
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What is the DOC for: myoclonic seizure
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Valproate
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What seizure med causes this S/E: gingival hyperplasia?
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Phenytoin
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What drugs are known for causing Steven-Johnsons syndrome (SJS)?
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Anticonvulsants (ethosuximide, lamotrigine, charbamazepine, phenytoin, phenobarbital), Antibiotics (sulfa drugs and PCN) and Allopurinol
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What drugs are known for inducing cytochrome p450 -> increased metabolism and breakdown of other drugs (less effective OCPs and Warfarin)
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Quinidine, Barbituate, St. John's Wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic Alcohol, Glucocorticoids
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Queen Barb Steals Phen-Phen and Refuses Greasy Carbs, Chronic Alcohol and Glucose
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Which drugs inhibit cytochrome p450?
(increase the amount of other drug) |
Alcohol, Ketoconazole, Erythromycin (macrolides), Grapefruit juice, Sulfonamides, INH, Cimetidine, Chloramphenicol, Omeprazol
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"Inhibit from drinking Alcohol from a KEG so you don't get SICCO"
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What is an Arnold-Chiari Malformation? What is it a/w?
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Downward displacement of the cerebellar tonsils and medulla through the foramen magnum. Type I (most common and often asymptomatic - HA or cerebellar sx); Type II - IV based on severity of other neuro anomolies
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What neurological anomalies are a/w Arnold-Chiari Malformation?
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Hydrocephalus, syringomyelia, Myelomenigeocele (herniation fo meninges and spinal cord)
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When NOT to give antibiotics in acute otitis media?
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ALL must be met:
age 6m-2yrs + dx questionable + illness not severe + f/up age >/= 2 yrs + illness not severe and f/up START antibiotics if no improvement in 2-3 days |
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What is DOC for acute otitis media? What is most common pathogen?
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High dose Amoxicillin (10 days) or Augmentin (amoxicillin + claviunic acid) or cephalosporin
most commonly S. pneumoniae (or non-typable H.influenzae or viruses) |
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What is bullous myringitis? Most common organism? Treatment?
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bullous/vesicular inflammation of tympanic membrane; more painful than otitis media; large, reddish vesicles on the TM
Mycoplasma pneumoniae - Oral Erythromycin (macrolides) |
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What is mastoiditis? How do you make diagnosis?
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Sx days-weeks after otitis media; erythema, edema *tenderness being the ear!
*external ear displaced Do CT scan of mastoid process |
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What is a cholesteatoma? Treatment?
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Overgrowth of desquamated keratin debris in middle ear space -> erode ossicular chain and external auditory canal -> conductive hearing loss
- commonly a/w chronic otitis media PE: grayish-white "pearly" lesion behind or involving the TM, vertigo ** Tx: surgical removal (tympanomastoidectomy) and reconstruction of ossicular chain |
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What is Acute Labyrinthitis? vs. Vestibular Neuritis?
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- Acute onse of vertigo, N/V and horizontal nystagmus (suppressed with visual fixation, fast phase away from affected side) + hearing loss (not in vestibular neuritis)
single episode lasting days to 2 weeks * proceded by viral URI or acute otitis media |
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How do you diagnosis and what is the treatment for acute labyrinthitis (vestibular neuritis)
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Dx: abnormal head thrust test - pt unable to maintain visual fixation when rapidly turn pts head
if > 60 yo get MRI (r/o schwannoma) Tx: Steroid taper, antiemetics (only for first 48hrs) |
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What is the most common cause of conductive hearing loss in adults? What does test show?
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Otosclerosis (need hearing aid) and wax
negative (or abnormal) Rinne Test (BC>AC) Audiometry - preserved air conduction but low hearing threshold |
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What is the most common cause of sensorineural hearing loss in adults? What does tests show?
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Presbycusis (elderly high frequency hearing loss)
+ (normal) Rinne test (AC>BC) and asymmetric Weber test ( to unaffected ear) Audiometry - both impaired bone and air conduction |
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What are the 5 sx of Meniere's Disease? What is it? What does audiometry show?
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Chronic disorder (short exacerbations) caused by distention endolymphatic compartment of ear
H/P: 1. acute vertigo (hrs) 2. N/V 3. decreased hearing 4. ear fullness/pressure 5. tinnitus Audiomentry: low-freq hearing loss |
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What is the treament for Meniere's disease? What is a common complication/greater risk for?
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Salt restrict + thiazide, anticholinergics; surgical decompression
depression/suicide (b/c tinnitus) |
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What is an acoustic neuroma (schwannoma)?
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benign tumor of schwann cells of CN 7; presents with hearing loss, dizziness, tinnitus, unilateral facial palsy**
- 3rd most common primary brain tumor in adults |
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What is Status Epilepticus? What is most common cause? What is the treatment? Mortality rate?
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prolonged (>20-30min) or repetitive seizures w/o consciousness
- most commonly d/t medical noncompliance/withdrawal TX: 1. ABCS/rapid intubation 2. IV benzo (lorazepam or diazepam) + loading dose of phenytoin (prevent recurrence) 3. phenobarbital load >20% mortality if not controlled properly |
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What electrolyte abnormality can cause seizures?
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hyponatremia
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What do you follow to decide whether or not to intubate Myasthenia gravis pt?
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Serial FVCs
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What is Ramsey Hunt Syndrome? Treatment?
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herpes zoster oticus
Tx: Valacyclovir (famciclovir or acyclovir), oral steroids, narcotics PRN |
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What is intranuclear opthomoplegia (IOP)?
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damage to the MLF - cannot ADduct eye on side of lesion and nystagmus in other eye (convergence normal) - Think MS
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What is the treatment for ALS? How do you dx it?
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Riluzole (decrease glutamate excitability) and may slow progression
Clinical exam (LMN signs in at least 2 extremities and UMN sign in one) EMG/nerve conduction studies can help- show widespread denervation and fibrillation potentials + motor block |
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What are the 3 most common primary brains tumors in adults? In kids?
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Glioblastoma multiforme, Menigioma, Schwannoma (MGM Studios)
Astrocytoma, Medulloblastoma, Ependymoma (AMEn) |
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What are the 7 C's of Huntington's Disease?
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1. CAG repeat (>30) on
2. chromosome Cuatro (4) 3. Caudate + putamen atrophy on MRI 4. aCh and GABA decreased 5. Crazy (dementia) 6. Choreoform movements 7. Cuarenta (40) = age onset |
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What disease has 100% penetrance and what does this mean? What else do they have?
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Huntington's: proportion of people with the genetic mutation that will exhibit clinical sx (but not symptomatic until about age 40) . Also anticipation.
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What are the drugs used in treatment of Alzheimer's? What is death usually due to?
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Cholinesterase inhibitors (Donepezil, rivastigmine, galantamine) and NMDA receptor antagonist (Memantine).
Death secondary to aspiration pneumonia (or other infections) |
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What are the drugs used to treat Parkinson's disease?
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Levodopa + Carbidopa (decarboxylase inhibitor that decreases levodopa metabolism-so decrease amt needed + S/E)
Selegiline (MAO-B inhibitor) - used early in disease (neuroprotective) Dopamine agonists (Bromocriptine - ergot) Anticholinergics:(trihexyphenidyl, benztropine) for tremor Amantadine - increase dopamine release |
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What are two unique features of Pick's disease?
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1. initial sx: behavior and Personality changes (inappropriate social conduct)
2. progressive aphasia (dysarthria - trouble speaking) |
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What are 3 unique features of Lewy Body Dementia?
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1. parkinsonian features (cogwheel, resting tremor, rigidity)
2. visual hallucinations 3. repeated unexpected syncopal episodes (falls) |
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What are eosinophilic cytoplasmic inclusions in neurons?
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Lewy bodies
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What do you see in Parkinson's disease on MRI?
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depigmentation of substantia nigra (b/c decreased melatonin byproduct of decreased DA) and abnormal (increased) Ach input to cortex
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What is the classic triad for MS?
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1. scanning speech
2. intranuclear ophthalmoplegia 3. nystagmus T-cell mediated; more as move away from equator (cooler); worsens with stress and hot showers |
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What is Dawson's finger's? Lhermitte's sign?
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-multiple asymmetric periventricular white matter lesions (esp. in corpus collosum) in MS
-sharp pain traveling up or down the neck w/ flexion |
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What is fixed oscillation of heads or head (using increases with stress, familial, or activities)? What is Tx?
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Benign essential tremor
Propanolol (or Primidone) |
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What is Athetosis? What disease is commonly seen in?
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"snake-like" movements of extremities
Cerebral palsy (also wilson's and huntington's) |
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What are the 3 most common tumors that metastasize to the brain? (75%)
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1. Lung
2. Breast 3. Melanoma |
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What are the common sx seen in Neurofibromaosis I (von Recklinghausen's)? What is the inheritance? What gene is mutation?
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COFFINS:
Cafe-au-lait spos (6) Optic glioma Freckling (axillary or inguinal area) Fam Hx - first degree relative (AD) Iris (pigmented-brown) hematomas (Lisch nodules) Neurofibromas Skeletal lesions (early) - gene on chromosome 17 |
clue: COFFINS
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What is signs/sx of NF II? What chromosome?
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Bilateral (2) acoustic neuromas defective gene on chromosome 22
(neurofibromas, gliomas, schwannoma, meningiomas, seizures, cafe-au-lait spots, skin nodules) |
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What is H/P for Tuberous Sclerosis?
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CCAARRSSS
Cardiac rhabdomyoma (apex LV - CHF) Calcified tubers - CT head "Ash-leaf" hypopigmented lesions (trunk + extremeities) Angiomyolipomas Retinal lesions (mulberry tumors (nerve head) + phakomas (round, flat, gray lesions near optic disc)) Renal harartomas and polycystic dz Spasms (infantile) Sebaceous adenomas (small red nodules on nose and cheeks) Shagreen patch (rough papule in lumbosacral w/ orange-peel consistency) MR and small benign tumors |
CCAARRSSS
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What causes slowing of nerve conduction velocity? What causing a silent EMG at rest (no muscle activity) and decrease in amplitude of muscle contraction on stimulation?
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demylination
intrinsic muscle disease (myositis or muscular dystrophy) |
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What is the treatment for Guillain Barre?
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Plasmapharesis or IVIG (NO steroids)
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Patient with normal sleep cycles, an inability to perceive and interact with the environment, and preserved autonomic function for > 1 month?
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persistent vegetative state
- recovery unlikely if > 3 mo |
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What test is used to confirm the most common cause of syncope?
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Tilt test -> Vasovagal=reflex syncope (emotional stress, trauma, pain, sight blood, prolonged standing; also micturition, defecation, GI stimulation)
- this is also used to dx orthostatic hypotension |
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Fast (theta wave) is sleep stage?
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Stage 1
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Slow frequency, high amplitude (delta wave) is sleep stage?
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Stage 3 and 4
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High frequency, low amplitude (B waves) is sleep stage?
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REM sleep or awake
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Sleep spindles, k-complexes is sleep stage?
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Stage 2
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What sleep patterns do you seen in the elderly commonly?
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decreased stage 3 and 4, decreased total REM, increased REM latency
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What sleep patterns is commonly seen in depressed patients?
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decreased stage 3 + 4, increased total REM, decreased REM latency (like narcolepsy)
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What do benzo's do to sleep?
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They increase stage 2 sleep and decrease stage 3+4 (shy used for for night terrors and bed wetting)
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What stage of sleep do nightmares happen in? Night terrors?
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nightmares = REM
terrors = 3+4 |
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What is the H/P for ALS?
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*asymmetrical limb weakness
- intact sensory and bladder - dementia, dysarthria, dysphasia -UMN + LMN - 5 years life expectancy |
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What is the only treatment for insomnia that is FDA approved for long-term use?
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Lunesta (Eszopiclone)
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What is Wernicke's Encephalopathy Triad? What is Korsakoff's?
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- damage to mammillary bodies (if give glucose before thiamine in alcoholic worsens -> Wernicke's)
1. encephalopathy 2. ophtalmoplegia (nystagmus, LR palsy, conjugate-gaze palsy) 3. ataxia (polyneuropathy, cerebellar and vestibular) - plus amnesia/confabulation (irreversible) |
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10 YO boy develops worsening arm + leg weakness over period of days that has now worsened including symmetrical facial muscles weakness. DTR are absent, and senstation is INTACT. What is DX?
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Guillian Barre Syndrome (acute, rapidly progressive demyelinating of peripheral nerves (LMN) -> bilateral ascending weakness)
- Campylobacter jejuni (also CMV, EBV, mycoplasma) |
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How do you DX Guillian Barre?
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EMG or nerve conduction studies = diffuse demyelination
CSF = albuminocytological dissociation (elevated protein > 55, w/ norm WBC count) |
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Differential DX for dislocation of the lens of the eye?
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1. Alports syndrome
2. Marfan's (upwards) 3. Homocystinuria (downwards) |
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How can Weber's test help you distinguish between conductive hearing loss from sensorineural? And Rinne?
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Webers:
Conductive: heard best in affected ear Sensorineural: heard best in unaffected ear Rinne: Conductive: negative (abnormal) BC>AC Sensorineural: positive (normal) AC>BC Sensorineural: |
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How is BPPV dx? How is it treated?
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Dx: Dix-Hallpike Maneuver
Tx: placement therapy: Epley maneuver |
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What is differential dx for cherry-red spot on macula?
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1. Central artery occlusion
2. Tay Sachs 3. Neimann Picks |
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What is the treatment for macular degeneration? What is the treatment for retinal detachment?
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Macular: Vit C, E, copper and zinc (atrophic)
intravitreal rhanuzimad (exudative) Detachment: surgery, cryotherapy or lazer |
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What are the risk factors for development of cataracts? How does it present? How do you Dx?
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AGE, DM, sunlight exposure, trauma (caustic), corticosteroids
H/P: progressive hazy + blurred vision, spots/glares with bright lights, difficultly driving at night or reading fine-print Dx: opacity of LENS + decreased/absent red reflex |
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What are classical features that distinguish orbital cellulitis from periorbital cellulitis? Treatment for orbital?
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Orbital involves actual eye: (vision loss, dyplopia, limitation of eye movement + pain, proptosis)
Tx: IV vancomycin + IV cefotaxime (or ceftriaxone) until afebrile + clinically better (3-5days) then oral antibiotics may need to consult optho or ENT for possible debridement surgery Periorbital only involves the skin around the eye |
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What eye abnormality is seen when there is a lesion to CN 3 (oculomotor n.)?
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eye is down and out
fixed + dilated ("blown pupil") b/c lost parasympathetics |
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What is pupillary afferent defect?
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damage prior to pretectal nucleus
- no constriction of both eyes when light shone in affected eye BUT constriction of both if shone in unaffected eye |
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What is pupillary efferent defect?
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damage to oculomotor nerve (CN 3)
- unaffected eye will constrict when light shone in either eye but affected eye will never constrict |
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What is amblyopia?
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decreased vision d/t disruption in normal development of vision prior to age 10 (usually from strabismus, cataracts or refractive error)
- presents with estropia (inward deviation), exotropia (outward), diplopia, or refractive error not correctable with lenses |
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What is the most common cause of blindness in the US: over age 55? under age 55? AA of any age?
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1. Macular degeneration
2. DM 3. Glaucoma |
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What causes RED eye + may indicate a collagen-vascular disorder?
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Uveitis
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What causes RED eye + potential serious complication of corneal ulceration?
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Herpes simplex/zoster keratitis
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What causes RED eye + colored halos?
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Acute angle-closure glaucoma
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What causes RED eye + itching eye?
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Allergic conjunctivitis
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What causes RED eye + preauricular lymph node enlargement?
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Viral (Adenovirus) Conjunctivitis
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What causes RED eye + "dry eyes"?
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Kertoconjunctivitis sicca (Sjogren's syndrome)
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What causes RED eye + shallow anterior compartment (on slit lamp)?
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acute angle-closure glaucoma
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What is #1 cause of conjunctivitis? What does it present with commonly?
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Viral (adenovirus) - causes diarrhea too
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#1 cause of conjunctivitis if sexually active?
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N. gonnorrhea or Clamydia = purulent + copious 24/7
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Which glaucoma is more common? Which is mostly bilateral? What is RF?
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OPEN-angle (for both)
older age (>40), AA, DM |
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What is def dx for open-angle glaucoma?
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Dx: cup:disc ratio > 50%
also tonometry shows increased IOP (vision loss is peripheral -> central) -cupping of optic disc, frequent lens changes prescriptions |
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What are RF for CLOSED angle glaucoma? How does it present? How Dx?
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Asian, Pupillary dilation (prolonged time in dark, stress, meds), older age
- extreme PAIN and blurred vision, N/V, "halos" around light DX: with Slit lamp; hard, red eye (narrowing of anterior chamber angle and obstructed drainage of aqueous humor), fixed, pupil mid-dilated and NONreactive to light |
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Treatment for angle-closure glaucoma?
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Med Emergency: Timolol drops (B-blocker) + Acetazolamide (carbonic anhydrase inhibitor) + Pilocarpine
if refractory: mannitol IV, lastly surgery - Laser peripheral iridotomy |
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What is the treatment for open-angle glaucoma and what does it do?
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Prevention is most impt but
1. Timolol (topical B-Blocker) + 2. alpha-agonists = both decrease aqueous humor production 3. Cholinergic agonists (Pilocarpine) - increases aqueous humor outflow 4. prostaglandin analogues |
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What is the difference between a chalazion and hordeolum?What are treatments?
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Chalazion - inflammation of INternal Meibomian sebaceous gland (eyelid swelling)
Tx: self-limiting or surgical excision/intralesional steroid injection * if recurrent do histopathological exam because risk for sebaceous carcinoma (+ looks like BCC) Hordeolum (Stye): infection of EXternal sebaceous gland of Zeiss or Mol (tender, red swelling on LID MARGIN - usually lower) Tx: hot compresses, if unresolved then I+D +/- antibiotic ointment |
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What is Anterior Blepharitis? What is Tx?
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infection of eyelids and LASHES secondary to seborrhea (red, swollen lid margins + dandruff on lashes)
Tx: wash lid margins daily w/ shampoo, remove scales with cotton ball, antibiotic ointment |
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Treatment for Corneal Abrasion?
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Topical antibiotics ointment (erythromycin, sulfacetamide, cipro, ofloxacin) + OTC lubricant PRN + oral systemic opioids or opthalmic NSAIDs (diclofenac, keorolac
NEVER topical steroid or anesthetic! |
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What do you seen in patient with Vit A deficiency?
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- night blindness or blindness
- xerophthalmia - Bitot's spots (areas of abnormal squamous cell proliferation and keratinization of the conjunctiva) |
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How do you dx Macular degeneration?
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Funduscopy - pigmentary or hemmorhagic disturbance in macular area
Fluorescein angiography - neovascular membranes and retina Central -> peripheral vision loss |
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What complication may arise from performing an LP in a patient with increased ICP?
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Uncal herniation of brainstem
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A child presents to ER with mental status changes, hypoglycemia and lesions suggestive of chix pox? What is likely dx?
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Hepatoencelopathy (Reye's syndrome) - hypoglycemia is hepato
aspirin to kids causes |
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What is the most effect way to prevent bacterial meningitis in newborns?
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Give mom PCN G (or ampicillin) during labor
GBS + |
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How does sx of encephalitis differ from meningitis?
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Encephalitis has focal neurological sx too!
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Comparing ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage: what are the different BP goals and meds used?
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Ischemic stroke: </= 210/120 (labetalol or nicardipine-di CCB)
if want to use tPA (streptokinase) BP <185/110 Intracerebral + SAH: <150-160 systolic (labetaolol OR nitroprusside (for intracerebral) / nimodopine-di CCB (for SAH) |
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What is the treatment for nephrogenic DI d/t lithium?
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HCTZ + amiloride (K+ sparking diuretic - specific for lithium)
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What are signs/sx of TCA OD? What is Tx?
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3 C's:
Cardiotoxic (QT prolongation, arrhytmias) CNS Anticholinergic Tx: Na+bicarb +/- benzos for seizures |
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What is tardive dyskinesia? Treatment?
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repetitive motions, lipsmacking, chorieoform movements; possibly irreversible
Tx: just stop antipyschotic (and switch to atypical-Risperdal or Clonzapine) |
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What is the most common complication of recurrent otitis media?
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Hearing Loss!
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Elderly patient presents with HA and dilated right pupil. During the hx she reports she fell at home 5 days ago. What is likely dx?
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RIGHT (same) sided subdural hematoma
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What meds (other than stimulants) used to treat ADHD?
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Clonidine (alpha2-agonist), TCAs, bupropion
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What meds are used in treatment of Tourettes?
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Pimozide
Fluphanezine, tetrabenazine (Clonidine if ADHD too) |
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What are the most worrisome S/E of ADHD drug atomoxetine?
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Strattera - increased suicidal ideation + LIVER injury
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What SERUM lab abnormalities might you seen in patient with bacterial meningitis?
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increased WBCs (w/ left shift) or decreased
30% have HYPOnatremia |
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Patient comes to clinic with complaint of hearing loss + vertigo. On exam of TM you notice a grayish-white "pearly" lesion involving the TM. Dx is?
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Cholesteotoma
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