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Neuro Ck

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isolis's version from 2016-07-27 13:19

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Question Answer
• Most common organisms causing orbital cellulitis? Complications if untreated?staph aureus, strep pneumo. Brain abscess, cavernous sinus thrombosis possible if untreated.
• Pure motor stroke, think thisinternal capsule, often due to small vessel lacunar strokes
• Paralysis post ictaltodd's paralysis
• This drug is approved for use with patients with ALS, what is it and how does it work?Riluzole is a glutamate inhibitor
• ipsilateral ataxia, nystagmus, intention tremor and loss of coordination, think thiscerebellar tumor
• What is waterhouse-friderichsen syndrome?adrenal hemorrhage causing sudden vasomotor collapse and petichiae and purpuric lesions following meningococemia. Basically 100% death for sure
• Dantrolene is used to treat ____, benztropine is used to treat ____NMS, Extrapyramidal side effects of antipsychotics
• Waddling gait, thinkmuscular dystrophy
• Hypokinetic gaitparkinson's or parkinsonion feature
• Transient vision loss lasting a couple of seconds with sudden head position changesdue to papilledema
• "Milder" form of Neurofibromatosis type II?gardner syndrome
• Bilateral deafness, hyperpigmented café au lait spots, subcutanous nodulesNeurofibromatosis type II
• Most common site of hypertensive hemorrhages in the brain? Resulting deficit?putamen, lies next to internal capsule causing contralateral hemiparesis
• Acute angle glaucoma, gold standard for evaluating?gonioscopy, measures some angle or something. If that's not available, do tonometry which measures intraocular pressure
• Leading risk factor for cerebral palsy and other nonprogressive motor dysfunction syndromesprematurity.
• Patients with peripheral artery disease and claudication are at increased risk ofMI and stroke. Only 1-2% progress to ischemia and amputation.
• Young woman, double vision, fatigued easilymyasthenia
• Most common neoplasm associated with NF1?optic pathway glioma causing blurry vision.
• Treatment of myasthenia crisis with respiratory failure?intubate, then give steroids and IVIG or plasma exchange
• Most common supratentorial brain tumor in kids?benign astrocytoma
• Numbness or pain between 3rd and 4th toes, clicking sensation when palpating space between those toes while squeezing the metatarsal jointsmorton neuroma. This occurs in runners
• Burning, numbness, or aching of distal plantar surface of the foot or toes that can radiate up to the calf. Due to compression of a nerve as it passes through the ankle due to fracture around ittarsal tunnel syndrome
• Central retinal artery occlusion is treated withocular massage and high flow oxygen administration
• Unsteady gait, weakness in lower limbs, decreased vibratory/position sense in legs, deformed feet wth high arches. MRI shows cervical spinal cord atrophy and some cerebellar atrophy. Possible EKG changes too. What is this and how is it inherited?Friedreich ataxia. This is autosomal recessive. Most patients wheelchair bound by 25 and dead by 35 due to arhtyhmia because of myocarditis.
• Sudden loss of vision, loss of fundus detail, and sudden onset of "floaters", what is this and which patients is it more common in?vitreous hemorrhage, typically occurs in diabetic retinopathy patients
• Correcting hyponatemia too quickly can cause ___. Correcting hypernatremia too quickly will cause ___osmotic demylnatation syndrome, hypernatremia correcting too quickly will cause cerebral edema (b/c water will flow into the neurons)
• Autoantibodies to post synaptic receptors? Autoantibodies to V gated calcium channelsmyasthenia, lambert eaton.
• Basal ganglia hemorrhage sx?look TOWARDS lesion, (gaze palsy) contralateral hemiparesis or weakness. A thalamic hemorrhage, eyes would look AWAY from the lesion (towards hemiparesis)
• Gradual loss of peripheral vision leading to tunnel vision in an old personopen angle glaucoma. Acute closure is sudden and very painful
• All patients with clavicular fractures should haveangiograms, basically a careful neurovascular exam to make sure plexus and subclavian artery are gucci
• Treatment of immunocompromised patient with suspected bacterial meningitis?vanco, ampicillin, cefepime (or ceftazadime)
• Most common organisms of bacterial meningitis?strep pneumo, neisseria meningitis, listeria
• Bilateral periorbital edema with CN 3, 4, 6 deficits and severe headache?cavernous sinus thrombosis, can be infectious, diagnose with MRI and treat with antibiotics
• Dendriform corneal ulcers and vesicular rash in trigeminal distrubtion on face in an old person or immunosupressed patientherpes zoster opthalmicus (shingles)
• Cauda equina syndrome vs conus medullaris?cauda equina is lower motor neuron signs (hyporeflexic, asymmetrcial weakness) and conus medularis is upper motor neuron signs (hyperreflexia, symmetric motor weakness)
• Medulloblastomas develop in which part of the brain?vermis of cerebellum
• Progressive vision loss, straight lines appear wavymacular degeneration. Drusen deposits on macula, common lesions with this disorder. Dry vs. wet (new vessels scar retina).
• This nerve damaged with uncal herniationocculomotor
• Spinal muscular atrophy (aka Werdnig hoffmann disease) vs botulism?botulism affects pupils, other one doesn’t, and weakness if greater in lower extremities than upper in werdnig hoffmann
• Neurofibromatosis I symptoms?Café au lait spots, big head, feeding problems, short, learning disabilities
• CSF of elevated protein, decreased glucose indicative ofbacterial meningitis.
• Do a CT in patients with myasthenia, why?b/c thymoma is often present
• PMR vs polymyositis?PMR patients are NOT WEAK. They have pain. Polymyositis patients are weak in proximal muscle groups and have elevated CK as well
• This can be used to manage pain in fibromyalgia patientsamitriptyline
• Elevated WBC count, lymphocytic predominance, normal glucose, elevated protein on CSFviral
• Hallmark of cryptococcal meningitis?subacute presentation with VERY HIGH OPENING PRESSURE on spinal tap
• Empiric treatments for bacterial meningitisIV ceftriaxone and vanco
• Dermatomyositis is associated withcancer. Ovarian, lung, stomach, colorectal or NHL. Do a cancer screen!
• Duchenne muscular dystrophy vs Beck's ?duchenne is absent dystrophin, beck is milder and has decreased.
• Intrinsic hand muscles, facial muscles, delayed muscle reactionmyotonic dystrophy
• In this type of stroke, patient has a history of hypertension, and symptoms begin as focal deficits and progress over minutes to hours.intracerebral hemorrhage
• This anticonvulsant can be used to treat benign essential tremors. What side effect can it have?primidone, it can precipitate acute intermittent porphyria (abdominal pain, neurological/psych issues). First line for treatment of essential tremors is a beta blocker
• Solitary brain metastasis treatment in patients with stable extracranial cancer? What about patients with multiple brain mets?surgical resection, whole brain radiation if multiple
• Calcified parasellar lesion on MRI in a kidcraniopharyngioma
• Visual field deficits with craniopharyngioma vs pineal gland tumor?cranoiopharyngioma you get bitemporal hemionopsia and with pineal gland tumors you can't look up.
• Down syndrome patient presenting with upper motor neuron signsatlantoaxial instability
• Rapid correction of hypOnatremia?central pOntine myelinolysis. HypErnatremia treatment too quick would lead to cerebral edEma
• Increased total brain volume associated with ?Autism
• Abnormalities in orbitofrontal cortex and striatum associated withOCD
• Decreased volume of amygdala associated withpanic disorder
• Decreased hippocampal volume associated withPTSD
• Elevated protein only on CSFGuillan barre. Maybe increased cells but not much
• Very low glucose and increased cells on CSF?fungal or tuburcular meningitis
• Treatment for guillan barre?plasmapheresis in adults or IVIG in children to reduce severity/length, but this is self limiting usually
• Causes for pseudotumor cerebri?Vitamin A, Isotretinoin, withdrawal from steroids, tetracyclines
• Pancoast tumors causing hoarseness, think of thisaffecting vagus nerve (CN 10) which is the efferent limb of the gag reflex and innervates muscles in the pharynx. Sensory afferent is glossopharyngeal n (CN9).
• What is a complex partial seizure?simple partial (focal) seizures followed by impairment of consciousness. First line treatment is valproate or lamotrigine. For simple partial, first line is carbamazepine
• Treatment for status epilepticuslorazepam. Fosphenytoin if seizures persist
• Treatment of stroke if no blood is seen on CT?aspirin, DO NOT PICK HEPARIN ON STEP 2. TPA can be attempted if within 3 hours of symptoms and meet criteria
• When should you choose carotid endarterectomy over aspirin/clopidogrel for TIA?if stenosis is 70 - 99%
• Treatment of EPS symptoms of antipsychotics?Dystonia - benztropine or diphenhydramine. Treat akathisia with beta blockers. Parkinsonism - benztropine or amantadine. Treat NMS with cooling, fluids, and dantrolene
• Intention tremor is usually a result of what part of the brain being diseased? What about hemibalismus?cerebellar disease, subthalamic nucleus
• Inheritance of benign hereditary tremor, treatment?auto dominant, treat with beta blockers
• Areflexia, loss of vibration/position sense, cardiomyopathy, what is this and what's it's inheritance pattern?friedreich ataxia, autosomal recessive
• Progressive cerebellar ataxia, immune deficiency, and oculocutaneous telangiectasias? What is this and what is the defect?ataxia telangiectasia. Defect in DNA repair. High risk of cancer. Progressive cerebellar degeneration
• Pathophysiology of werdnig-hoffmann? Inheritence?autosomal recessive, degeneration of anterior horn cells in the spinal cord and brainstem, so it's lower motor neuron degeneration. Hypotnoic at birth for most, all affected by 6 months. Treatment is supportive only
• Treatment for clostridium botulinum intoxication?Antitoxin (passive immunity) + supportive, may need intubation for respiratory muscle paralysis. Spontaneous recovery within 1 week usually
• Ethambutol neuro side effect?optic neuritis.
• Pathophys of myasthenia? Lambert eaton?destruction of acetylcholine receptors. Impaired release of acetylcholine from nerves due to antibodies to calcium channels on presynaptic neuron
• Normal life expectancy with this muscular dystrophy. Autosomal dominant, affects the face and shoulder girdlefacioscapulohumeral dystrophy. Sx start between 7 and 20
• This muscular dystrophy affects pelvic and shoulder muscles and begins in adulthoodlimb-girdle dystrophy
• This eye finding is usually present with inherited mitochondrial myopathies aka "ragged red fibers" on biopsyopthalmoplegia
• Cramping and weakness after exercise due to lactic acid build up, looks like a muscular dystrophy with presentation but isn't reallythis is McArdle disease, a glycogen phosphorylase deficiency (glycogen storage disease). Relatively mild
• Skull fractures of calvarium (roof of the skul) are best seen on ___. Treatment if not contaminated or impinging on anything?CT, preferred over plain X ray. Heal on their own, only do surgery if it's contaminated and stuff
• Increasing blood pressure, bradycardia, and respiratory changes, thinkincreased ICP. This is cushing triad
• Meningocele vs myelomeningocele? Patients with a myelomeningocele almost always have what?meningocele is just meninges protrudcing outside of the spinal canal. Myelomeningocele is meninges plus CNS tissue. Almost always associated with an Arnold Chiari Malformation
• Pure sensory stroke?Thalamic,
• Dysarthria/clumsy hand syndrome?base pontine stroke, a type of lacunar stroke
• HIV patient, headache, signs of Increased ICP but normal MRI, what is this?cryptococcal meningitis. Diagnose by CSF testing for antigen or organism itself.
• Parkinsonism (rigidity) with autonomic dysfunction and impotence/incontinenceShy Drager syndrome aka multi system atrophy
• Treatment for acute spinal cord compressionimmediate surgical exploration
• Treatment for restless leg syndrome?pramipexole (dopamine agonist) and gabapentin (alpha 2 delta calcium channel ligand)
• Rapidly progressing ascending paralysis, no sensory paralysis, but normal CSFtick borne paralysis, find tick and remove it causing spontaneous improvement in most patients
• What can precipitate a myasthenic crisis?infection, surgery, or fluoroquinolones. Life threatening complication with respiratory muscle weakness that can lead to respiratory failure.
• Stroke in sickle cell patient, how do you treat?exchange transfusion. Happens because of SLUDGING
• These three drugs can be used to treat migraines acutelyNSAIDs, triptans, and antiemetics (eg metoclopramide, prochlorperazine, chlorpromazine), especially in those patients with accompanying n/v
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