Step Up to Medicine - Neurology

arold001's version from 2015-12-30 21:44

Section 1

Question Answer
Name 3 hypercoaguable states/disease for young pts that puts them at increase risk for embolic strokes?protein C and S deficiencies, antiphospholipid antibody syndrome, factor V ledien mutation
what is subclavian steal syndrome?stenosis of subclavian artery proximal to origin of vertebral artery --> exercise of left arm causes reversal of blood flow down the ipsilateral vertebral artery to fill the subclavian artery distal to the stenosis bc it CANT supply adquate blood to left arm --> decrease BP and pulse in left arm compared to right
what type of stroke: pt awakens from sleep with neurological deficitsTHROMBOTIC stroke
name the 4 types of lacunar strokes?1) pure motor lacunar stroke
2) pure sensory lacunar stroke
3) ataxic hemiparesis
4) clumsy hand dysarthrtia
lesion to which artery causes contralateral weakness, sensory loss, hyperreflexiaMCA
how many days after a stroke does cerebral edema occur?1-2 days after stroke and may last for up to 10 days
if the pt is given tPA, what should there BP be?<185/110
if a stroke pt presents after 3 hours (after tPA window) what do you give?ASA. If cant take ASA, give Clopidogrel. if not Ticlopidine
what are the 3 most common areas of intracerebral hemorrhages?basal ganglia (66%), pons, cerebellum
wheres the bleed in pts with ICH who show: pinpoint pupils?pons
wheres the bleed in pts with ICH who show: poorly reactive pupilsthalamus
wheres the bleed in pts with ICH who show:dilated pupilsputamen
why would SAH cause communicating hydrocephalus?blood within subarachnoid space is hindering normal CSF flow

Section 2

Question Answer
in PD, dopanergic neurons are lost in which 2 areas in the midbrain?substania nigra and LOCUS CERULEUS in the MIDBRAIN
what disease: parkinsoniam symptoms + autonomic insufficiencyShy-Drager Syndrome
name 3 neuroleptic drugs that cause parkinsonian side effects?haloperidol, chlorpromazine, perphenazine
what disease: parkinsonian symptoms (bradykinesia, limb rigidity, cognitive decline) , NO tremor, ophthalmoplegiaprogressive supranuclear palsy (PSP)
loss of GABA-ergic neurons in the caudate and putamenhuntingtons disease
MRI shows atrophy of head of caudatehuntingtons disease
what are 3 drugs used to tx tourettes syndrome1) clonidine (alpha agonist)
2) pimozide (D2 receptor antagonist = antipsychotic)
3) haloperidol
name 2 types of vascular dementia1) multi-infact dementia
2) Binswanger disease = diffuse subcortical white matter degeneration seen in pts with longstanding HTN or atherosclerosis
whats the tx of Alzheimers Disease?cholinesterase inhibitors = Donepezil, rivastigmine, galatamine
lesion to where causes internuclear ophthalmoplegia?lesion to MLF
ipsilateral medial rectus palsy on attempted lateral gaze (adduction defect) and horizontal nystagmus of abducting eye (contralateral to side of lesion)internuclear ophthalmoplegia
what does the evoked potential test measure?measures speed of nerve conduction within the BRAIN = GOOD TEST FOR DEMYELINATION
whats the tx for acute MS attack?IV steroids (NOT oral)
name 2 disease modifying therapy/drugs in the tx of MSIFN-b and glatiramer acetate

Section 3

Question Answer
inflammatory demyelinating polyneuropathy that primarily affects MOTOR neuronsGB
rapidly ascending weakness/paralysis with PRESERVED sensation and sphincter controlGB!
what drug do you NOT give in GB pts?dont give steroids! they dont help GB pts
what cancer is a/w lambert eaton myasthenic symdrome?small cell lung carcinoma
what is myathenic crisis?diaphragm and intercostal muscles fatigue causing respiratory failure
whats the inheritance pattern for DMD?x-linked recessive
whats the tx of choice for pts with DMD?STEROIDS = increases strength and muscle function
autosomal recessive, muscle cramping after exercise due to glycogen phosphorylase deficiencyMcArdles Disease
glycogen phosphorylase deficiencyMcArdles Disease
another name for von Recklinghausen DiseaseNF-1
cafe au lait spots, meningiomas, lisch nodules, neurofibromasNF-1
which disease: capillary angiomatosis of the pia matersturge weber syndrome
what brain tumor is a/w VHL?cavernous hemangiomas of brain
name a brain tumor and cancer a/w VHLrenal cell carcinoma and pheochromocytoma

Section 4

Question Answer
whcih spinal cord disease: contralateral loss of pain and temp, ipsilateral hemiparesis (CST), ipsilateral loss of position/vibrationbrown-sequard
which spinal cord disease: lower extremity weakness, back pain, sensory deficits below level of lesion, urinary retentiontransverse thoracic myelitis
what drug do you give with pts with BPV?meclizine
whats menieres disease triad?vertigo, tinnitus, hearing loss
vertigo, tinnitus, hearing lossmenieres disease
whats the tx of menieres disease?sodium restriction and diuretics
why do pts with vasovagal syncope faint? whats wrong with them?in pts with vasovagal syncope, the compensatory response is interrupted in a few minutes by a paradoxical WITHDRAWAL of sympathetic stimulation and replacement by enhaced parasympathetic (VAGAL) activity --> inappropriate bradycardia, vasodilation, decrease in BP, decrease cerebral perfusion
name 2 drugs used to tx vasovagal syncopebeta-blockers and disopyramide
what test do you do to determine vasovagal syncopetilt-table test
what 2 drugs of choice for tonic-clonic seizures and partial seizures?carbamazepine and phenytoin
disorder affecting anterior horn cells and CST tracts ALS
UMN and LMN signs seen in what disease?ALS
what 5 things remain normal/unaffected in pts with ALS1) bowel/bladder control 2) SENSATION 3) cognitive function 4) EOM 5) sexual function
what 4 things make up the bulbar area?face, larynx, tongue, jaw
whats the tx for ALS?Riluzole = glutamate blocking drug
what parts of the face are affected in Bells Palsy?both upper and lower parts of the face = due to LMN lesion

Section 5

Question Answer
Lesions in the cerebral cortex cause 2 main deficits1) contralateral motor or sensory deficits 2) aphasia
name the 4 parts of the subcortical area1) internal capsule
2) cerebral peduncles
3) thalamus
4) pons
hemiparesis seen in cortical lesion affects which body parts? as compared to subcortical lesions?cortical lesions: face, arm and trunk
subcortical lesion: face, arm, LEG (neurons controlling these structures all merge together subcortically
in spinal cord disease, how can u determine the level of the lesion?level of the lesion corresponds to SENSORY level
whas the most common cause of lumbosacral pleoxpathy (motor and sensory deficits)postsurgical hematoma
what nerve roots are a/w Erb-duchenne brachial plexus?C5/C6 = UPPER TRUNK
what nerve roots are involved in lumbrosacral plexus?L5-S3
whats a clue that youre dealing with plexopathy?you will have deficits in motor/sensory in >1 nerve
how do you know you have a radiculopathy (defect in roots)?pt presents with weakness, atrophy and sensory deficits in a DERMATOME pattern