Step 2 Secrets (Neuro)

Front 1

in what common situation is an LP contra-I? what should you do beforehand? what is the risk?

Back 1

1. acute trauma or signs of intracranial HTN (eg. papilledema)
2. do LP only after a neg. CT or MR scan of head
3. uncal herniation and death

Front 2

what are the 4 variables in CSF fluid?

Back 2

# cells/ml
glucose (mg/dl)
protein (mg/dl)
pressure (mmHg)

Front 3

normal CSF?

Back 3

0-3 cells (L)
50-100 glu
20-45 protein
100-200 mmHg

Front 4

CSF findings in bacterial meningitis? viral/asceptic meningitis?

Back 4

1. >1,000 cells (PMN), <50 glu, ~100 protein, >200 mmHg

2. >100 cells (L), nl glu, normal to hi-normal prot., normal to hi-normal pressure

Front 5

CSF findings in pseudotumor cerebri? Guillan-Bare syndrome?

Back 5

1. nl cells, nl glu, nl prot, >200 mmHg

2. 0-100 cells (L), nl glu, >100 prot., nl pressure

Front 6

CSF findings in cerebral hemorrhage? MS?

Back 6

1. bloody sample (RBC's), nl glu, >45 prot., >200 mmHg

2. nl to hi-nl cells (L), nl glu, nl to hi-nl prot., nl pressure

Front 7

CSF findings in TB and fungal meningitis? what about fungal meningitis with positive India ink prep?

Back 7

lo glu (<50) with hi cells (>100)(L)

pos. India ink=cryptococcus neoformans

Front 8

classic description of MS?

Back 8

- white women 20-40yrs with insidious onset of neuro symptoms w/ exacerbations and remissions

- paresthesias and numbness
- weakness and clumsiness
- visual disturbances (decr. vision and pain due to optic neuritis, diplopia due to CN involvement)
- gait disturbance
- incontinence and urgency
- vertigo
- emotional lability and MS changes
- internuclear ophthalmoplegia and scanning speech are classic
- pt may have pos. Babinski's sign

Front 9

most sensitive test for MS? tx?

Back 9

- MRI to show demyelination plaques
- IgG and oligoclonal bands and possibly myelin basic protein in CSF

tx: corticosteroids, interferons, glatiramer acetate (these are not very effective)

Front 10

what is Guillain-Barre syndrome? describe the hx. what is the hallmark of the syndrome?

Back 10

- postinfectious polyneuropathy

hx: mild infx (esp. upper respiratory) or immunization about 1 wk before onset of symm., distal weakness or paralysis with mild paresthesias that start in the feet and legs w/ loss of DTRs in affected areas

hallmark: motor function is affected w/ intact or mildly impaired sensation

Front 11

can the ascending paralysis in Guillain-Barre syndrome cause respiratory paralysis?

Back 11

YES. use spirometry to follow ability, and intubation could be necessary

Front 12

how do you dx Guillain-Barre? how can you decrease severity and length of the disease?

Back 12

clinical presentation. CSF is nl except for increased protein

improve sx and slow disease w/ plasmapheresis

Front 13

should you use steroids in Guillain-Barre?

Back 13

NO. you could make the condition worse.

Front 14

name 2 demyelinating diseases. how is conduction velocity affected?

Back 14

MS and Guillain Barre. velocity is slowed

Front 15

what causes and EMG study to show fasciculations or fibrillations at rest?

Back 15

LMN lesion (ie. peripheral nerve problem)