Neurology

Front 1

Drug regimen for status epilepticus?

Back 1

1) lorazepam (ativan) 0.1 mg / kg or 2g bolus.
2) phenytoin (Dilantin) or phosphophenytoin 20 mg/kg
3) either try repeating lorazepam + 1/2 dose of phenytoin or intubate and give phenobarb 20mg/kg.

Front 2

CSF profile with increased OP, increased WBC up to 100k, increased protein 100-500, and low glucose

Back 2

bacterial meningitis.

Front 3

Dosing for tPA?

Back 3

0.9 mg/kg give 10% as bolus and remainder over 1 hr. Have 3-4.5 hr window.

Front 4

branches off of internal carotid-

Back 4

main intercranial branches:
opthalmic a- occlusion causes monoccular blindness
post. communicating
anterior choroidal a- occlusino causes C/L hemiparesis, hemisensory loss and homonymous hemianopsia
then ICA splits into ACA and MCA

Front 5

proximal ICA occlusion causes?

Back 5

C/L homonyous hemianopsia, hemiparesis and hemisensory loss
monocular blindness (I/L)
global aphasia if on Left

Front 6

occlusion of ACA?

Back 6

weakness of CL lower extremity
bladder weakness
frontal signs- loss of inhibition, perseveration, apathy

Front 7

MCA trunk occlusion?

Back 7

CL weakness of upper extremity and face
if on R- hemineglect of L
if on L- global aphasia
C/L honomymous hemianopsia

Front 8

An infarction where causes:
broca's aphasia
C/L UE and facial weakness
C/L inferior quadrantanopsia

Back 8

superior division of MCA

Front 9

An infarction where causes:
homonymous superior quadrantanopsia
C/L neglect
Wernicke's aphasia
C/L weakness of face and arm

Back 9

inferior division of MCA

Front 10

Weakness of CL face, UE and LE with no sensory changes or aphasia means what artery feeding what structure was injured?

Back 10

The lenticulostriate artery feeding the posterior limb of the internal capsule was hit.

Front 11

PCA infarction causes?

Back 11

migrane HA, confusion, C/L macula sparing homonymous hemianopsia, color anomia, agnosias. Also possibly brainstem ischemia. The PCA supplies occipital cortex and inferomedial temporal lobes.

Front 12

Locked in syndrome is caused by an occlusion where?

Back 12

Basilar artery proximal occlusion. Kills much of brainstem.

Front 13

nausea, vertigo, ataxia and nystagmus make you think of lesion where?

Back 13

cerebellar infarct

Front 14

What syndrome:
I/L Horners (recall sympathetic chain and V are long tracts), loss of pain/temp (spinothalamic) on I/L face and C/L body, vertigo (XIII), n/v, nystagmus, agsent gag (IX), dysphagia, hoarseness (X), hiccups, I/L ataxia (cerebellum).

Back 14

Wallenburg-PICA infarction.

Front 15

CN? in
midbrain
pons
medulla

Back 15

CN? in
midbrain III-IV
pons V, VI, VII, VIII
medulla IX, X, XI, XII
5 and 8 are not easily localized as they traverse the brainstem.

Front 16

dysarthria, clumsy hand syndrome is due to ?

Back 16

C/L genu of IC

Front 17

combined hemiparesis and hemisensory loss means?

Back 17

infarct at C/L posterior limb of IC (lenticulostriates) and C/L thalamus

Front 18

cause of pure C/L hemisensory loss

Back 18

C/L ventral posterior thalamus

Front 19

hemiballismus is caused by injury to ?

Back 19

C/L subthalamic nucleus

Front 20

LP shows increased OP, 50-500 WBC (lymphs), increased protein, very low glucose.

Back 20

TB meningitis, get acid stain.

Front 21

Difference in cell type between viral and bacterial meningitis?

Back 21

viral - lymphs
bacterial - neutrophils (many more)

Front 22

LP shows normal OP, 10-500 neutrophils (early on then lymphs), normal protein, normal glucose

Back 22

viral meningitis.

Front 23

What diagnostic test should you never perform if it is determined that there is a brain abscess?

Back 23

never do LP as that can rupture abscess

Front 24

Most common organisms for brain abscess and empiric therapy?

Back 24

strep, staph aureus, G- and anaerobes.
Treat with Pen G + Flagyl + cephalosporin and Decadron if significant edema to reduce swelling

Front 25

You see ring enhancing lesions on CT in an AIDS pt. What is next test?

Back 25

Do toxo IgG and IgM titers. Then treat with sulfadiazine and pyrimethamine + folic acid and Decadron to reduce swelling.

Front 26

On CT you see scattered interparanchymal calcifications. The individual has eaten undercooked meats. What is it and how do you treat?

Back 26

cysticercosis- from tinea solium.

Give albendazole or praziquantal with steroids.

Front 27

TB CSF profile? See cerebral granulomas.

Back 27

Increased OP, increased WBC lymphs 50-500, increased protein and decreased glucose.

Front 28

Name 3 instances of decreased glucose on LP

Back 28

bacterial meningitis, TB meningitis (very low), fungal meningitis, and sometimes neurosarcoidosis

Front 29

What level are the reflexes:
biceps
brachioradialis
triceps
patellar
ankle

Back 29

What level are the reflexes:
biceps C-5
brachioradialis C-6
triceps C-7
patellar L-4
ankle S-1

Front 30

If the UE are spared and it is a spinal lesion what level must you be below?

Back 30

T1 (brachial plexus is C5-T1)

Front 31

What disease process?
weakness more so in the arms then the legs with decreased pain and temp in the arms not easily localizable.

Back 31

syrinx

Front 32

What disorder?
Loss of pain and temp in cape like distribution with weakness and hyporeflexia in UE

Back 32

Arnold Chiari syrinx

Front 33

What condition:
afferent papillary defect, internuclear opthalmoplegia, deffect in adduction in conjugate gaze on affected size due to MLF... also sensory or weakness or loss of proprioception.

Back 33

MS- think of oligoclonal bands and increased IgG in CSF

Front 34

Uhthoff's and Lhermitte's phenomenon

Back 34

MS:
heat sensitivity worse in hot
electrical like sensation shooting down spine with neck flexion

Front 35

CSF profile in MS?

Back 35

WBC < 20 lymphs
mild elvated protein < 60
IgG elevted
OCBs

Front 36

Drug Tx for MS?

Back 36

IFN- monitor LFT and CBC monthly for 3 mo.
- Avonex
-Rebif
- Betaseron
Glatiramer acetate (Copaxone)
mitoxantrone (Novantrone) for secondary progressive.

Front 37

3 drugs to tx MS spasticity

Back 37

botox, baclofen, tizanidine

Front 38

Describe R INO

Back 38

left eyes moves laterally abductin but right eye can't adduct (MR) ... shows nystagmus in teh abducting eye

Front 39

incontinence + dementia + ataxia =

Back 39

Normal pressure hydrocephalus

Front 40

Common CSF finding with guillain barre syndrome

Back 40

albuinocytologic dissociation with high protein but low cell number.

Front 41

spasticity + hyperreflexia + atrophy + wasting and weakness asymmetrically especially of ahnds and extraocular muscles.... means?

Back 41

amyotrophic lateral sclerosis.

Front 42

drug causes of PD?

Back 42

antipsychotics, antiemetics0 metoclopramide (Reglan), prochlorperazine (Compazine), promethazine (phenergan).
Li, Depakote, Diltiazem

Front 43

3 dopamine agonists?

Back 43

bromocriptine (parlodel), ropinerole (Requip), pramipexole (Mirapex)

Front 44

Name 2 anticholinergics and 3 MAOB inhibitors to tx PD

Back 44

trihexyphenidyl (Artane), benztropine (Cogentin)
selegiline (Eldepryl) , zydis selegiline (Zelapar), rasagiline (Azilect)

Front 45

Entacapone and Tocapone used with L DOPA have what side effects / risks?

Back 45

dyskinesia, diarrhea, fulminent hepatitis

Front 46

Treatment for Hungtington's disease?

Back 46

antipsychotics for chorea and tx depression.