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152 Cards in this Set
- Front
- Back
What are the three signs of an UMN lesion?
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hyper reflexia
weakness |
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What are the signs of a LMN lesion?
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fasciculations
atrophy weakness |
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What is clonus?
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maintained reflex
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What would a lesion of the arcuate fasciculus cause?
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normal language, but cannot repeat
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Where is a lesion if language is involved?
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cortex
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what part of the brain involves cranial nerves 9 and 10?
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medulla
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what is wallenbergs?
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alternation pain and temp
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What artery might have an infart if wallenberg is the result? And what would be the cause?
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PICA
thrombus |
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What is brown-sequard?
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hemi-sected spinal cord
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Go bottom up in localization
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muscle
neuromuscular junction LMN UMN Cortex |
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What should you test on the general examination?
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Pulse, bruit, heart rhythm and blood pressure in case of stroke
orthostatic blood pressure measurements with syncope temporal artery palpataion palpation of muscles to look for tenderness in myopathy |
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Breakdown the mini mental state test of higher intellectual function
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Attention
Orientation Memory Calculation Abstract thought Spatial orientation Vision Language |
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What is asomatognsia
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inability to recognize body parts
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what is anasognosnia
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unaware of weakness or defecit
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what is the word for inability to feel an object being drawn?
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agraphestheisa
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what is prospognosia?
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inability to recognize faces
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what is asteriognosis
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inability to recognize objects placed in the hand
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What do you test for in language?
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comprehension
fluency naming repetition reading writing |
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when can you see multiple cranial nerves deficites?
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basilar meningitis- TB, fungal, carcinomatous
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What divides LMN VII vs. UMN VII?
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UMN VII- motor cortex to mid-pons
LMN VII- lower pons prior to decussation |
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Where in the brainstem does the facial nerve originate?
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mid-pons
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where in the brainstem does the hypoglossal originate
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medulla
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What are the two possible sites of lesion if both pain and strength are impaired?
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periphery or cortex
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What is the site of a lesion that has one side w/ pain temp loss and the opposite side w/ vibration/position sensation loss?
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spinal cord on the side of the vibration/sensation loss.
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if there is pain/temp loss on one side of the face and the other side of the body, where is the lesion?
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between the pons and C2
ipsilateral facial numbness |
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What is the difference in ptosis presentation for third nerve palsy and Horner's?
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both cause ptosis and pupillary asymmetry
third nerve-> ptosis on the large pupil side horner's on the small pupil side. |
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Where is the lesion when Diplopia is present?
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brainstem or periphery, no tthe cortex
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where is the lesion in a gaze palsy?
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cortex or brainstem, not the periphery
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Where is a lesion that causes dysarthria?
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subcortical, brainstem, or cerebellar lesion.
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What three signs in headache necessitate an MRI?
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papilledema
focal neurologic defecit recent onset or positional headaches |
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what medications treat partial seizures?
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carbamazepine
phenytoin oxcarbazepine valproic acid phenobarbital |
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what medications treat absence seizures?
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ethosuximide
valproic acid |
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what is the risk of using valproic acid and lamotrigine?
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lamotrigine must be started at a very low dose. it can lead to a severe skin reaction.
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abulia
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loss of initiative, willpower or drive
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acalculia
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inability to calculate
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agnosia
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inablitity to recognize one or meor classes of environmental stimuli, even though the necessary intellectual and
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Gerstmann's
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Right-Left confusion
agraphia acalculia finger agnosia angular gyrus in dominant hemisphere |
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what are the centers of alertness?
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both cerebral hemishperes
thalamus reticular activating system. |
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Where is the lesion in someone who demonstrates impersistance, perseveration
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bilateral prefrontal cortex
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What is the first branch of the ICA?
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ophthalmic artery.
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athetosis
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slow, sinuous writing of the distal parts of limbs
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ballism
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violent, large-amplitude, involuntary flinging movementes of the proximal parts of limbs
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festination
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involuntary tendency for steps to accelerate and decrease in amplitude
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what part of the brain is most involved in tremor?
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basal ganglia
(striatum, globus pallidus, substantia nigra, subthalamic nucleus |
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Hyperkinetic movement disorders
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involuntary movements
- chorea - athetosis - ballism |
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what are the hallmark signs of parkinsonism?
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bradykinesia
rigidity resting tremor postural instability |
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How is dystonia classified?
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focal- specific localized muscle groups
segmental- two or more contiguous areas of the body multifocal- two or more not contiguous areas of the body hemidystonia- one side of the body generalized- entire body |
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dystonia
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involuntary , sustained muscle contractions with preferred direction
abnl posture. |
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what causes postural and kinetic tremors?
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abnl cerebellar outflow to the thalamus
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what is alpha-synuclein
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principal component of LB
maintains the integrity of neurotransmitter vesicles. mutation of this gene-> parkinsons. |
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Progressive supranuclear palsy
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parkinsons tremor
downgaze palsy then an upgaze palsy then difficulty with voluntary horizontal gaze. oculocephalic reflexes are intact neck dystonia and rigidity occur. |
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What is the treatment for progressive supranuclear palsy?
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tricyclics
dopamine agonists antidepressants methysergide |
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Corticobasal degeneration
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after 50
presents with clumsiness, stiffness, or jerking of one arm spreads to involve the ipsilateral limb dystonic posturing, apraxia can cause alien limb rigidity and bradykinesia |
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Multiple System Atrophy
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combo parkinsons, cerebellar dysfunction, autnomic impairment
spasticity, CN abnlties, ant horn cell dysfunction. Peripheral polyneuropathy in any combination. 2/3rds have REM sleep behavior disorder. |
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what is the difference between MSA-C and MSA-P?
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C- cerebellar predominant
P- Parkinsons predomninant |
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What is shy-drager syndrome?
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parkinsons and autonomic symps in MSA-P
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What are teh pathologic changes in MSA?
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neuronal loss in striatum, brainstem, cerebellum, and spinal cord nuclei w/ selective nitration of alpha-synuclein in glial cytoplasmic inclusions.
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Friedreichs ataxia
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AR ataxia
early in adolescence with progressive gait difficulty loss of position and vibration sense in the lower extremities no tendon reflexes in the lower extremities. ataxic gait, speech. |
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what is the underlying genetic cause of friedrichs?
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unstable expansion of GAA
frataxin protein |
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Ataxia telangiectasia
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first decade of life.
develops an ataxic gait, followed by upper extremity ataxia and ataxic speech. difficulty initiating gaze |
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what is the mutation in ataxia telangiectasias?
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poinositol 3 kinase
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spinocerebellar ataxia
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dominant inheritance
differentiation requires genetic testing. slow progression. mutation is an expanded CAG sequence |
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torticollis
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patients head turned to one side, flexed, extended, tilted, or any combo
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blepharospasm
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blilateral eye closure- exacerbated by bright light
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writer's cramp
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hand assumes an infoluntary twisted posture when writing.
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generalized dystonia
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seen in kids, DYT1 gene is AD w/ low penetrance.
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what is the treatment for focal dystonia?
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botulinum toxin
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What are the neurologic symps of Wilson's disease?
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copper toxicity- tremor, dystonia, dysarthria, dysphagia, congitive detriorationa nd psychiatric symps.
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What will a slit-lamp show in Wilson's disease?
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Keyser-Fleishcer rings in most of those with neuro symps.
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What are some instances to use CT over MRI?
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skull fracture
intracranial bleeds- acute bleeds are white on CT w/in 20 min. Trauma- CT is faster and safer. Hydrocephalus- ventricles are easily seen, faster and cheaper |
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What is white in T2 MRIs?
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edema and water accumulation.
(and CSF, but the other stuff is pathologic) DWI- Ischemia appears white. |
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What are the CSF results in Bacterial meningitis?
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Increased PMNs
decreased gcose Increased proteins increased opening pressure cloudy |
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CSF in viral meningitis
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Increased monos
noraml gcose maybee increased protein and opening pressure clear |
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CSF in SAH
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increased blood, RBCs and WBCs, increased protein
yellow/red |
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GBS CSF
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increased protein
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MS CSF
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increased gammaglobulin
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CSF pseudotumor
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increased opening pressure
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Cheyne-Stokes respirations
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crescendo-decrescendo from bilateral hemisphere dysfunction
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Central neurognic hyperventilation
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rapid deep breathing due to midbrain damage
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Apneustic breating
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prolonged inspirations with apnea from pontine dysfunction
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Ataxic breating
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irregular breating from medullary dysfunction.
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What are the causes of delirium?
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MOVE STUPID
Metabolic Oxygen Vascular Endocrine/Electrolytes Seizures Trauma/Tumor/Temp Uremia Psychogenic Infection/Intox Drugs/Degeneration |
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What are the differences between delirium and dementia?
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Delirium- Fluctuating orientation, stupor or agitated, rapid onset, reversible
Dementia- memory loss, normal arousal, slow development, irreversible. |
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what are the five As of Dementia?
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Amnesia
Aphasia Apraxia Agnosia Abstract thought |
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What are the causes of dementia other than alzheimers?
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DEMENTIA
Degenerative disease- Park, Pick, Hunting, LBD Endocrine- Thyroid, Parathyroid, pit-adrenal axis Metabolic- alcohol, fluid e-lytes, b12, gcose, hepatic/renal Exogenous- heavy metals, CO, drugs Neoplasm Trauma- subdeural hematoma Infection- Meningitis, encephalitis, abscess, endocarditis, HIV, syphilis, prions, Lyme disease Affective disorders- Pseudodemitia 2ry to depression Stroke/Structure- Multi-infarct, ischemia, vasculitis, normal pressure hydrocephalus |
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what are some drugs used in alzheimers?
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Anticholinesterase inhibitors
Rivastigmine galantamine donepezil Anti-oxidants- Vit E- Alpha tocopherol selegiline |
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rivastigmine
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AChE inhibitor
- alzheimers |
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galantamine
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AChE inhibitor
- alzheimers |
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donepezil
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AChE inhibitor
- alzheimers |
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alpha-tocopherol
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vit E
antioxidant for alzheimers |
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selegiline
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anti-oxidant
for alzheimers |
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Meniere's disease
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intermittent vertigo from dilation and periodic rupture of the endolymphatic compartment of the inner ear.
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What is the DDx for peripheral vestibular disorders?
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BPPV
Meniere's disease peripheral vestibulopathy otosclerosis cerebellopontine-angle tumor vestibulopathy/acoustic neuropathy |
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What is the DDx for acute central ataxias?
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Drugs
Wernicke's Vertebrobasilar ischemia Bertebrobasilar infarction Inflammatory disorders Cerebellar hemorrhage |
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What is the DDX for chronic central ataxias?
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MS
Cerebellar degen hypothyroidsim Wilson's CJD Posterior fossa mass Ataxia-telangiectasia |
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what agents can be used prophylactically in migraine?
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B-blockers- propranolol
Ca-channel blockers- verapamil TCA- amitriptyline Valproic acid |
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What is abortive therapy for cluster headaches?
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100% O2, sumatriptan, erogts, intranasal lidocaine, corticosteroids
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What is the prophylactic treatment for migraines?
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Ca-channel blockers
ergots valproic acid prednisone topiramate methysergide |
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Astrocytoma
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Headache and increased ICP
Unilateral paralysis in CN V-VII and X Slow, protracted course Good prognosis Resection or rads |
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GBM- Grade IV astrocytoma
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most common 1ry brain tumor
presents w/ headache and ICP rapid progression Rx- Surgery, Rads |
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Meningioma
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Originates from the dura mater or arachnoid
good prognosis increased incidence w/ age Surgical resection; radiation for unresectable tumors |
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Acoustic neuroma
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Ipsilateral hearing loss, tinnitus, vertigo, and cerebellar dysfunction
Schwann cells Surgery |
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Medulloblastoma
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Kids
4th ventricle-> increased ICP Malignant, may spread to subarachnoid space Surgery, rads, chemo |
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Ependymoma
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Common in kids
arise from ependyma of a ventricle or spinal cord |
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bromocriptine
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increases dopa tone
good for parkinsons |
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Pramipexole
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increases dopa tone
good for parkinsons |
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What is the Rx for huntingtons?
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Reserpine- decreases unwanted movements
Haloperidol- for the psychosis Antidepressants Benzos- for anxiety Genetic counseling for offspring |
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Lhermitte's sign
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electrical sensation running down the spine and into the lower extremities w/ neck flexion
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Uthoff's phenomenon
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exacerbation of weakness w/ heat.
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What is the Rx for MS?
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ABC
Avonex- IFN B 1a Betaseron- IFN B 1b Copaxone- copolymer 1 Steroids for acute exacerbations - PT and symptomatic treatment. |
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Lennox-Gastaut
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Juvenile epilepsy, 1.5-2 Hz, loss of body tone
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west syndrome:
what is it, what is it's treatment? |
infantile spasms
ACTH |
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What drug is used in complex partial seizures
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Carbamezapine, phenytoin
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Absence seizures
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ethosuximide
divalproex sodium |
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what is the Rx for seizure in preeclampsia
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MgSO4
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what is the treatment for trigeminal neuralgia?
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carbamazepine
phenytoin gabapentin Not Effective: indomethacin, valproic acid |
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What neurologic disease is associated with trigeminal neuralgia?
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MS
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what is similar between facial pain and trigeminal neuralgia?
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unilateral
facial pain is constant, trigeminal is paroxysmal |
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what are some prophylactic medications for migraine
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verapamil
amitriptyline valproate propranolol |
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what are abortive againts
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Ergots
triptans metoclopramide |
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what is the manifestation of encephalitis lethargica?
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movement disorders
parkinsons |
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What nerve is damaged in sarcoid?
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VII
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How do you treat Toxo?
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Sulfadiazine and Pyrimethamine
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what is the Rx for JC on top of HIV?
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HAART
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What CN does Lyme disease affect?
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III
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what eeg is seen with HSV?
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bilateral epileptiform discharges
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how do you treat lyme disease?
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ceftriaxone
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what is the Rx for Rabies
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Supportive therapy
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What is the Rx for CMV?
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gancyclovir
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what is a gumma?
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largely avascular granuloma
seen in syphylis |
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what causess osteomyelitis in HIV?
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Aspergillus
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what is the most common cause of brain abcess in HIV?
normal people? |
toxo
strep |
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What virus causes SSPE?
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measles
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What is the hallmark of bartonella encephalitis?
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seizure
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what cells change in chronic liver failure?
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astrocytes
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what cells change in chronic liver failure?
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astrocytes
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in what dementia is myclonus common?
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CJD
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what is the triad of normal-pressure hydrocephalus?
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gait disturbance, dementia, and incontinence.
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What is the treatment for alzheimers?
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Donepezil
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what aphasia is common in alzheimers?
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Transcortical sensory aphasia
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what is the drug used when a long-term neuroleptic causes parkinsonism?
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Trihexyphenidyl
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what is the drug of choice for turet's
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haloperidol
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what is Meigs' syndrome?
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forceful blinking and grimacing movements, tongue protrusion
|
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locked-in syndrome
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paralysis with perserved conciousness.
infarction of the pons. |
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what is the role of baclofen in MS?
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anti-spasmodic
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Neuromyelitis optica
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bilateral optic neuritis with transverse myelitis.
|
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Adrenoleukodystrophy
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adrenal dysfunction with progressive degnerative disease.
x-linked. brain damage, atp binding transporter. |
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Pelizaeus-Merzbacher disease
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demylenation- sudanophilic leukodystrophies.
most are male. early onset |
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rapid hyponatremia correction in alcoholic casues what?
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central pontine myelinolysis.
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what part of the CNS does alcohol effect?
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superior vermis
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TOCP causes what?
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severe motor polyneuropathy
|
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how does lead kill kids?
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edema
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