Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
555 Cards in this Set
- Front
- Back
Q001. Parkinson's Disease - What is it; When does it start; Life expectancy
|
A001. ACh and dopamine must be in balance for normal, balanced movement; decreased levels of dopamine in substantia nigra; idiopathic hypokinetic; usually starts ~50-60 y/o; life expectancy ~ 9 yrs.
|
|
Q002. Parkinson's Disease - Insults that lead to; "parkinsonism"
|
A002. Most cases are idiopathic; insults decreased dopamine - postencephalitic; toxic insults - (carbon disulfide,"",manganese, MPTP); bihemispheric ischemic; traumatic; iatrogenic (neuroleptic meds)
|
|
Q003. Parkinson's Disease - History/PE
|
A003. Tremor at rest (pill rolling); cogwheel rigidity; bradykinesia; festinating gait; stooped posture; unstable posture; masked faces; memory loss; micrographia; shy-dragger- any autonomic dysfunction
|
|
Q004. Parkinson's Disease - Tx
|
A004. 1st - is it from a secondary cause that can be reversed?; then - how does patient function daily?; tremor but functioning - > 60 y/o – amantidine; < 60 y/o - anticholinergic; if can't function - l-dopa-carbidopa, most effective but most side effects; "response fluctuations": Tx fluctuations - COMT or selegiline list of meds:; L-dopa/carbidopa - mainstay; bromocriptine; selegiline; entacapone (COMT inhib); amantadine & anticholinerg - limited efficacy; If meds fail & disease advanced - deep brain stimulation of GPi and subthal nucleus, or pallidotomy - ablation of GPi (posteroventral GP), rarely done now
|
|
Q005. Huntington's - What is it
|
A005. Hyperkinetic; AD; atrophy of caudate; lose GABA; CAG triple repeats on C4p; anticipation - progression expansion; > 39 repeats - mutant genes
|
|
Q006. Huntington's - History/PE
|
A006. Presents ~30-50 y/o; gradual onset of - chorea; dementia; altered behavior; depression
|
|
Q007. Huntington's - Dx
|
A007. Clinical; CT; MRI; molecular genetic testing
|
|
Q008. Huntington's - Tx
|
A008. No cure; disease cannot be halted; genetic counseling; haloperidol - psychosis; reserpine - minimize unwanted movements
|
|
Q009. Alzheimer's - What is it
|
A009. MCC of dementia in elderly; senile plaques - B amyloid; neurofibrillary tangles - abnorm phosphorylated tau protein; loss of ACh in cortex - basal nucleus of Meynert; amyloid angiopathy => lg lobar hemorrhage; hippocampus affected early
|
|
Q010. Alzheimer's - Risk factors
|
A010. Age - most important; family history; Down's (> 35 y/o); female gender; chromosomes 21, 14; chromosome 1 - younger age; chromosome 19 - older; homozygous for ApoE4 - high rate of Alzheimer's
|
|
Q011. Alzheimer's - History/PE
|
A011. Amnesia usually 1st sign; then language deficits; acalculia; depression; agitation; apraxia
|
|
Q012. Alzheimer's - Evaluation
|
A012. Dx of exclusion; definitive Dx only on autopsy; MRI or CT - diffuse cortical and subcortical atrophy; Neuropsych testing - distinguish between dementia and depression
|
|
Q013. Alzheimer's - Tx
|
A013. Supportive therapy; Cholinesterase inhibitors - first-line therapy; donepezil; rivastigmine; galantamine; Vit E (a-tocopherol) - may slow cognitive decline
|
|
Q014. Alzheimer's - Complications
|
A014. Survival is 5-10 yrs from onset of sxs; death usually secondary to aspiration pneumonia or other infections
|
|
Q015. Delirium - What is it caused by; Timing of onset; Course
|
A015. Caused by acute illness, infection or drug toxicity; Sudden onset; Reversible (usually); impairment of consciousness - decreased awareness of your environment; can't maintain attention
|
|
Q016. Dementia - What is it caused by; Timing of onset; Course
|
A016. Caused by anatomic changes in the brain; Slow, gradual onset; Irreversible
|
|
Q017. Subarachnoid Hemorrhage - What is it
|
A017. Due to bleeding from ruptured aneurysm; MCC - head trauma (Circle of Willis) (considered separate disorder); spontaneous ruptured aneurysm, usually congenital berry, associated with APKD, coarctation of aorta; other cause - AV malformation, ~50-60 y/o; high mortality
|
|
Q018. Subarachnoid Hemorrhage - History/PE
|
A018. Sudden-onset headache; "worst headache of my life"; loss of consciousness; fever; n/v; neck stiffness; seizure; CN3 palsy - if berry aneurysm; may be preceded by milder sentinel headaches, weeks earlier
|
|
Q019. Subarachnoid Hemorrhage - Dx
|
A019. CT without contrast immediately. blood appears white; if CT neg - LP immediately, check for xanthochromia; no LP if increased ICP - sudden decreased in CSF pressure can cause further bleeding; 4-vessel angiography to pinpoint location
|
|
Q020. Subarachnoid Hemorrhage - Tx
|
A020. Prevent 2nd rupture - most likely in 1st 48 hrs; obliterate aneurysm; IV fluids; keep BP OK; nimodipine -prevent vasospasm; phenytoin; lower ICP - raise head of bed, hyperventilation; pain meds - no NSAIDs; surgery - clip aneurysm; IR (stent-assisted) coiling
|
|
Q021. Subarachnoid Hemorrhage - Complications
|
A021. 2nd rupture - especially with aneurysm; extend into brain parenchyma- especially with AVM; arterial vasospasm; obstructive hydrocephalus
|
|
Q022. Epidural Hematoma - What is it
|
A022. Often due to blunt trauma; usually lateral skull fracture; tear of Middle Meningeal Art.
|
|
Q023. Epidural Hematoma - History/PE
|
A023. Lucid interval - min. to hrs. then headache; progressive obtundation; hemiparesis; "blown pupil"
|
|
Q024. Epidural Hematoma - Dx
|
A024. CT - lens-shaped convex hyperdensity; close observation and serial neuro exams before surgery
|
|
Q025. Epidural Hematoma - Tx
|
A025. Neurosurgical evacuation
|
|
Q026. Subdural Hematoma - What is it
|
A026. Usually after head trauma; rupture of bridging veins; cortex to dural sinuses; especially elderly & alcoholics
|
|
Q027. Subdural Hematoma - History/PE
|
A027. Headache; change in mental status - days to weeks; can present as dementia in elderly; contralateral hemiparesis; may have remote history of fall
|
|
Q028. Subdural Hematoma - Dx
|
A028. CT - crescent-shaped; concave hyperdensity
|
|
Q029. Subdural Hematoma - Tx
|
A029. Neurosurgical evacuation; blood may regress spontaneously if chronic; corticosteroids; phenytoin
|
|
Q030. Parenchymal Hemorrhage - Causes
|
A030. HTN (usually in basal ganglia); tumor; amyloid angiopathy - elderly; vascular malformations - AVM; cavernous hemangiomas
|
|
Q031. Parenchymal Hemorrhage - History/PE
|
A031. lethargy; headache; focal mtr & sensory deficits; some obtundation
|
|
Q032. Parenchymal Hemorrhage - Dx
|
A032. CT without contrast; check for mass effect or edema
|
|
Q033. Parenchymal Hemorrhage - Tx
|
A033. Raise head of bed; antiseizure prophylaxis; neurosurgical evacuation - if mass effect, especially in posterior fossa
|
|
Q034. Coma - What is Rule of 4
|
A034. 1. Thiamine, D50, naloxone, coma cocktail; 2. 2 mechanisms: bilateral hemisphere or RAS; 3. 3 general disease processes: structural, metabolism, seizures; 4. 4 key aspects to exam
|
|
Q035. Coma - General Processes: Structural
|
A035. Hematoma; Infarction; Abscess; Tumor; Abnormal imaging lesion that occupies space
|
|
Q036. Coma - General Processes: Metabolism
|
A036. Electrolyte, endocrine or metabolic functions; substrate deprivation - O2, glucose, vitamin deficiency; organ failure – kidney; toxins – meds, etoh, drugs; infections; inflammatory disease; Normal imaging
|
|
Q037. Coma - General Processes: Seizures
|
A037. Status epilepticus; postictal
|
|
Q038. Coma - 4 aspects of exam
|
A038. Pupils; eye movement; motor response; ventilation pattern - acid-base status
|
|
Q039. Coma - Tx
|
A039. Stabilize the patient; Airway; Breathing; Circulation; Reverse the reversible - coma cocktail; O2; ID and tx underlying cause; Prevent further damage
|
|
Q040. Broca's Aphasia - What is it; What part of brain affected
|
A040. Disorder of language production; motor; broken speech; comprehension is intact; expressive or nonfluent aphasia; posterior inferior frontal gyrus
|
|
Q041. Broca's Aphasia - Features
|
A041. Repetition is impaired; frustration - cuz aware; associated with - arm and face hemiparesis, hemisensory loss, apraxis of oral muscles; often secondary to left superior MCA stroke
|
|
Q042. Broca's Aphasia - Tx
|
A042. Speech therapy; tx underlying condition; wide range of outcomes; intermediate prognosis
|
|
Q043. Wernicke's Aphasia - What is it
|
A043. Disorder of language comprehension; nonsensical production; Wernicke's is wordy; left posterior superior temporal; receptive or fluent aphasia
|
|
Q044. Wernicke's Aphasia - Features
|
A044. Neologisms; word substitutions; unaware - no comprehension; secondary to left inferior/post MCA stroke
|
|
Q045. Wernicke's Aphasia - Tx
|
A045. Speech therapy; tx underlying condition; poorer prognosis than Broca's
|
|
Q046. Brain Neoplasms - Mets vs. Primary
|
A046. Benign usually > 65 y/o Metas - Lots of Bad Stuff Kills Glia: Lung Breast Skin Kidney GI; metas > primary; supratentorial; at junction of gray and white matter; MC primary in adults - glioblastoma and meningioma; most 1o are supratentorial; MC primary in kids - medulloblastoma & astrocytoma; most 1o are infratentorial
|
|
Q047. Brain Neoplasms - Dx
|
A047. CT with contrast; MRI with gadolinium; CT-guided Biopsy; Biopsy during surgical tumor debulking
|
|
Q048. Brain Neoplasms - General Principles of Tx
|
A048. Resection (if possible); radiation; chemo; palliative tx; corticosteroids - reduce vasogenic edema; type of therapy depends on - type of tumor, histology, progression, site
|
|
Q049. Brain Neoplasms:; Glioblastoma - Characteristics and; Presentation
|
A049. Grade IV astrocytoma; MC primary brain tumor; prognosis grave, < 1 year to live; can cross corpus callosum; progresses fast; headache; ICP
|
|
Q050. Brain Neoplasms:; Glioblastoma - Tx
|
A050. Surgical resection; radiation and chemo; have variable results
|
|
Q051. Brain Neoplasms:; Meningioma - Characteristics and; Presentation
|
A051. 2nd MC primary; often incites osteoblastic reaction in overlying cranial bones; originate from dura or arachnoid; good prognosis; incidence increased with age
|
|
Q052. Brain Neoplasms:; Meningioma - Tx
|
A052. Surgical resection; radiation for unresectable
|
|
Q053. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Characteristics and; Presentation
|
A053. Derived from schwann cells; bilateral schwannoma in NF2; Ipsilateral hearing loss; tinnitus; vertigo; signs of cerebellar dysfunction; facial weakness; facial sensory loss
|
|
Q054. Brain Neoplasms:; Acoustic Neuroma (Schwannoma); Tx
|
A054. Surgical removal
|
|
Q055. Brain Neoplasms:; Astrocytoma - Characteristics and; Presentation
|
A055. Grades 1 - pilocytic, mainly kids; grade 2 - diffuse; grade 3 - anaplastic; grade 4 - glioblastoma multiforme; headache; increased ICP; can cause unilateral paralysis in CN 5-7 & CN10
|
|
Q056. Brain Neoplasms:; Astrocytoma - Tx
|
A056. Resection if possible; radiation
|
|
Q057. Brain Neoplasms:; Medulloblastoma - Characteristics and; Presentation
|
A057. Highly malignant; arises from cerebellum and 4th ventricle; can compress 4th ventricle; may seed subarachnoid space; increased ICP; morning headaches
|
|
Q058. Brain Neoplasms:; Medulloblastoma - Tx
|
A058. Surgical resection; coupled with radiation and chemo
|
|
Q059. Brain Neoplasms:; Ependymoma - Characteristics and; Presentation
|
A059. Common in kids; arises from ventricles and spinal cord; commonly found in 4th ventricle; can cause hydrocephalus
|
|
Q060. Brain Neoplasms:; Ependymoma - Tx
|
A060. Surgical resection; radiation
|
|
Q061. Neurofibromatoses - What are they
|
A061. NF1 - von Recklinghausen, AD, chromosome 17; NF2 - chromosome 22
|
|
Q062. Neurofibromatoses - History/PE
|
A062. NF1 - 2 or more of: neurofibromas (2), cafe-au-lait spots (6), freckling - axillary or inguinal, optic Glioma, lisch nodules (2), osseous abnorm, 1st degree relative with NF1; NF2 - bilateral acoustic neuromas or 1st deg. relative with NF2 and unilateral acoustic neuroma or 1st deg. relative with NF2 and neurofibroma, meningioma, Glioma or schwannoma
|
|
Q063. Neurofibromatoses - Dx
|
A063. MRI – brain, brain stem, spine; derm exam; ophthal exam; family History; hearing test
|
|
Q064. Neurofibromatoses - Tx
|
A064. No cure; tx symptoms; surgical removal for; acoustic neuromas
|
|
Q065. Tuberous Sclerosis - What is it
|
A065. Seizures - start as infant; mental retardation; skin and eye lesions; small benign tumors – brain, face, eyes, kidney, other organs; very variable clinical course; AD; chromosome 9
|
|
Q066. Tuberous Sclerosis - History/PE
|
A066. Infantile spasms; ash-leaf lesions – hypopigmentation, trunk and extremities; shagreen patch - lumbosacral; sebac. adenoma - nose, cheeks; mulberry tumors; phakomas
|
|
Q067. Tuberous Sclerosis - Dx
|
A067. CT - calcified tubers, periventricular areas, can => astrocytomas (rare); Wood's UV lamp - skin lesions; EKG; renal US
|
|
Q068. Tuberous Sclerosis - Tx
|
A068. Clonazepam or valproic acid; increased ICP - may indicate a tuber obstructing Foramen of Munro, surgery
|
|
Q069. Von Hippel-Lindau - What is it
|
A069. AD; deletion of VHL gene on ch 3; hemangioblastoma – cerebellum, medulla; retinal angioma; RCC; pheochromocytoma
|
|
Q070. Von Hippel-Lindau - History/PE
|
A070. Headache; N/V; cerebellar Sxs; retinal angiomas - usually periphery, can => retinal detachment
|
|
Q071. Von Hippel-Lindau - Dx
|
A071. CT - head, abdomen; MRI - posterior fossa emphasis, serpentine signal voids; angiography - vascularity; CBC - polycythemia; VMA levels in urine; ophthal US
|
|
Q072. Von Hippel-Lindau - Tx
|
A072. Surgical resection; or radiation
|
|
Q073. Osler-Weber-Rendu - What is it
|
A073. AD; also called - Hereditary Hemorrhagic Telangiectasia (HHT); telangiectasia and AVM in lungs, GI, brain; recurrent epistaxis
|
|
Q074. Osler-Weber-Rendu - History/PE
|
A074. Recurrent epistaxis; painless bleeding in bowel; hepatic AV fistula - (hepatomegaly, RUQ pain, pulsatile mass, palpable thrill, audible bruit, high-output CHF, liver failure); hepatic encephalopathy - portosys shunt; neuro complications; rightt-to-left shunt - (cyanosis, clubbing, hypoxemia, secondary polycythemia, exertional dyspnea)
|
|
Q075. Osler-Weber-Rendu - Tx
|
A075. Iron; folate; symptomatic tx of epistaxis; ASA - contraindicated; embolization,; surgical excision or ligation of AV fistulas
|
|
Q076. Closed-Angle Glaucoma - What is it
|
A076. Med emergency; usu older patients and Asians; iris root plugs opening of trabecular meshwork; acutely pupillary dilation; anterior uveitis; dislocation of lens
|
|
Q077. Closed-Angle Glaucoma - History/PE
|
A077. Intraocular pressure increased very fast; extreme periocular pain; acute red eye; blurred vision
|
|
Q078. Closed-Angle Glaucoma - Dx; Tx
|
A078. Best diagnostic test - tonometry; Tx – acetazolamide, pilocarpine - when P drops; laser iridotomy - curative
|
|
Q079. Open-Angle Glaucoma - What is it
|
A079. Most common form; almost always bilateral; risk factors - > 40 y/o, Black, diabetic, myopic, family History; diseased trabecular meshwork obstructs proper drainage => intraoc P increased gradually; progressive vision loss; vision loss - moves periph to central => blindness
|
|
Q080. Open-Angle Glaucoma - History/PE
|
A080. Asymp initially; suspect if patient - > 35 y/o, freq. lens changes, mild headaches, vision disturbances, impaired adaptation to dark; earliest defect - periph nasal fields; cupping of optic disk
|
|
Q081. Open-Angle Glaucoma - Dx
|
A081. Tonometry; ophthalmic exam of optic nerve. central field testing; evaluate on long-term basis; can be hard to Dx until advanced stages
|
|
Q082. Open-Angle Glaucoma - Tx
|
A082. Prevention; > 40 y/o - exam every 3-5 yrs; with increased risk factor - annually; timolol, betaxolol; pilocarpine; acetazolamide; laser trabeculoplasty - if meds fail
|
|
Q083. Macular Degeneration - What is it
|
A083. MCC of permanent bilateral vision loss in elderly; vision loss – central, do not lose peripheral vision; atrophic - gradual loss; exudative – faster, damage more severe
|
|
Q084. Macular Degeneration - History/PE
|
A084. painless loss of central vision; atrophic - irreg pigmentation of macular region; exudative – hyperpigmentation, pimple-like elevation of macula - from hemorrhage
|
|
Q085. Macular Degeneration - Tx
|
A085. Laser photocoagulation - may delay loss of central vision in exudative
|
|
Q086. Retinal Artery Occlusion - What is it; History/PE
|
A086. From emboli or thrombi; sudden, painless, unilateral blindness; pupil accommodates but reacts sluggishly to direct light; cherry-red spot on fovea; artery may look bloodless; retinal edema
|
|
Q087. Retinal Artery Occlusion - Tx
|
A087. Thrombolysis within 8 hrs of onset of Sx; decreased intraoc P - drain anterior chamber; IV acetazolamide
|
|
Q088. Retinal Vein Occlusion - What is it; History/PE
|
A088. Sudden, painless; retinal hemorrhages; cotton wool spots; edema of fundus; elderly; MCC - HTN; can => macular disease, glaucoma
|
|
Q089. Retinal Vein Occlusion - Tx
|
A089. Laser photocoagulation
|
|
Q090. Increased ICP - Causes
|
A090. Blood - EDH, SDH, SAH, ICH; spontaneous or traumatic; CSF - hydrocephalus; idiopathic intracranial HTN; brain mass - tumor; trauma -cerebral contusions; edema – trauma, tumors
|
|
Q091. Increased ICP - Signs in approx. order; of appearance
|
A091. N/V and headache; altered mental status; in kids - bulging fontanelles; papilledema; CN palsies - especially CN6; Cushing's Triad - (HTN, bradycardia, irregular breathing); end-stage - cerebral herniation
|
|
Q092. Increased ICP - Tx - in order
|
A092. Make sure BP and respiratory good; sedation; elevate head of bed; IV mannitol; hyperventilate to CO2 30-35; ventriculostomy; surgery - removal of hematoma, decompressive craniectomy
|
|
Q093. Herniation - What is it; Types; Dx
|
A093. Endpoint of untreated masses or increased ICP; specific signs and Sxs depends on type of hernia and mass lesion; uncal herniation - CN3 compression: ipsilat dilated pupil; midbrain compression: ipsilat hemiplegia; tonsillar herniation - respiration compromise; Dx - CT without contrast - rule out mass lesion or hemorrhage
|
|
Q094. Guillain-Barre - What is it
|
A094. Acute, rapidly progressive, acquired demyelinating autoimmune disorder of periph nerves; recent C. jejuni infection; viral infection; recent vaccination
|
|
Q095. Guillain-Barre - History/PE
|
A095. Rapidly progressive; ascending paralysis; involves trunk, diaph and CN; autonomic Sxs; areflexia
|
|
Q096. Guillain-Barre - Dx
|
A096. Diffuse demyelination on - EMG & nerve conduction studies; albuminocytologic dissociation; CSF protein > 55 mg/dL
|
|
Q097. Guillain-Barre - Tx
|
A097. ICU - risk of respiratory failure; plasmapheresis or IVIG; aggressive rehab
|
|
Q098. MS - What is it
|
A098. Acquired demyelinating disease; may have T cell-mediated autoimmune pathogenesis; environmental and genetic; female-to-male 2:1; 20-40 y/o; increased prevalence with greater distance from equator; risk - related to where lived the 1st 15 yrs. of life; subtypes – benign, relapsing/remitting, 2o progressive, chronic progressive
|
|
Q099. MS - History/PE
|
A099. Multiple neuro complaints in time and space, can't be explained by a single lesion; limb weakness; optic neuritis; paresthesias; diplopia; internuclear ophthalmoplegia; urinary retention; vertigo; Sxs wax & wane or progress; exacerbations – stress, infections, heat, trauma, vigorous activity
|
|
Q100. MS - Dx
|
A100. Multiple, asymmetric periventricular lesions in white matter; corpus callosum lesions - pathognomonic; active lesions enhance with Gado on MRI; increased CSF IgG, oligoclonal bands
|
|
Q101. MS - Tx
|
A101. Acute - steroids treat Sxs:; spasticity: baclofen or zanaflex; pain: phenytoin; fatigue: amantadine or provigil; avoid hot climates; prophylaxis: immunomodulators, reduce number of attacks, disability; Avonex - once weekly IM; Betaseron- every other day subq; Copaxone - daily subq
|
|
Q102. Stroke - Types
|
A102. Ischemic - 80%; emboli; thrombi; systemic hypoperfusion; hemorrhagic
|
|
Q103. Stroke - Risk Factors
|
A103. Age; male; race; HTN; diabetes; obesity; smoking; hypercholesterolemia; AF; carotid stenosis; coke; alcohol; IV drug user
|
|
Q104. Stoke - History/PE; MCA
|
A104. Aphasia; neglect; gaze preference; homonymous hemianopsia; contralateral hemiparesis - arm/face > leg
|
|
Q105. Stoke - History/PE; ACA
|
A105. Amnesia; personality changes; foot drop; gait dysfunction; cognitive changes; contralateral hemiparesis - leg > arm/face
|
|
Q106. Stoke - History/PE; PCA
|
A106. Homonymous hemianopia; memory deficits; dyslexia/alexia
|
|
Q107. Stoke - History/PE; Basilar
|
A107. Coma; CN palsies; apnea; visual Sxs; drop attacks; dysphagia
|
|
Q108. Stoke - History/PE; Lacunar
|
A108. Unilateral pure motor or sensory; dysarthria - clumsy hand syndrome; ataxic hemiparesis
|
|
Q109. Stoke - History/PE; TIA
|
A109. Transient neuro deficits; last < 24 hours; most last < 1 hour
|
|
Q110. Stoke - Dx
|
A110. CT without contrast - ischemic vs. hemorrhagic; MRI; EKG; echocardiogram; vascular studies - carotid US; MRA; transcranial doppler or MRA; screen for hypercoagulability; PE
|
|
Q111. Stoke - Tx; Preventive and Long-Term
|
A111. Vigilance for signs of - brain swelling: increased ICP, herniation; tPA - ischemic stroke if admin within 3 hrs. of onset of Sxs; ASA - ischemic stroke presenting within 48 hours; no hypotension, hypoxemia, hypoglycemia; tx aspiration pneumonia, UTI or DVT; Preventive & long-term Tx - * ASA, clopidogrel or dipyridamole/ASA; carotid endarterectomy; anticoags; management of HTN, DM and hypercholesterolemia
|
|
Q112. Carpal Tunnel Syndrome - What is it; Risk factors
|
A112. Median nerve compression where; passes thru carpal tunnel; women 30-55; Risk factors - repetitive use injury; pregnancy; DM; hypothyroidism; acromegaly; RA; obesity
|
|
Q113. Carpal Tunnel Syndrome - History/PE
|
A113. Wrist pain; numbness & tingling of 3 1/2; weak grip; decreased thumb opposition; thenar atrophy; nocturnal pain & paresthesias; Sxs may awaken patient at night; relieved by shaking wrist
|
|
Q114. Carpal Tunnel Syndrome - Workup
|
A114. Tinel's sign – tap, tingle; Phalen's sign - ph-lex (flex), paresthesias; EMG - to confirm; NCV - to confirm; evaluate for risk factors
|
|
Q115. Carpal Tunnel Syndrome - Tx
|
A115. Neutral wrist splint; modify activity; create ergonomic work environment; NSAIDs; corticosteroids - direct injection; surgery if Sxs persist - carpal tunnel release
|
|
Q116. Myasthenia Gravis - What is it
|
A116. Autoimmune: Ab that bind to postsynaptic Ach receptors (nicotinic); block receptors; lose receptors; young adult women; can be associated with – thymoma, thyrotoxicosis
|
|
Q117. Myasthenia Gravis - History/PE
|
A117. Muscle weakness increased in periods of activity; decreased after rest; Sx come and go; onset can be sudden; fluctuating fatigable ptosis; diplopia (double vision); dysphagia (swallowing); dysarthria (speech); Sxs worsen throughout day; myasthenic crisis - so severe, respiratory failure and aspiration, secondary to weakness, often secondary to infection (respiratory muscles compromised); ocular myasthenia - common variant, if doesn't spread in 2-3 yrs, probably won't
|
|
Q118. Myasthenia Gravis - Dx
|
A118. Edrophonium (tensilon test) - diagnostic; abnormal single-fiber EMG: decreased response to repetitive nerve stimulation; antistriatal ab if thymoma; chest CT - evaluate for thymoma
|
|
Q119. Myasthenia Gravis - Tx
|
A119. Neostigmine (treat Sx); pyridostigmine (treat Sx); prednisone; plasmapheresis or IVIG - temp relief (wks) if severe; thymoma resection
|
|
Q120. Amyotrophic Lat. Sclerosis - What is it
|
A120. Progressive neurodegenerative disease; unknown etiology; degeneration of motor neurons; UMN and LMN degenerate => respiratory failure and death
|
|
Q121. Amyotrophic Lat. Sclerosis - History/PE
|
A121. Slowly progressive weakness; may have fasciculations initially; UMN and LMN
|
|
Q122. Amyotrophic Lat. Sclerosis - Dx
|
A122. Clinical presentation; EMG and nerve conduction studies; CT/MRI - cervical spine, check for lesions; rule out systemic causes - CBC TSH SPEP UPEP; Ca2+ PTH PFTs; urine for heavy metal - (if history of exposure)
|
|
Q123. Amyotrophic Lat. Sclerosis - Tx
|
A123. Supportive; patient education; pulmonary specialist; riluzole
|
|
Q124. Thiamine (B1) Deficiency - What are Signs/Sxs
|
A124. Wernicke's: inadeq intake or absorption; excessive alcohol interferes with GI absorption and liver storage; acute onset – confusion, opthalmoplegia – nystagmus, lateral rectus palsy, conjugate gaze palsy, abnormal pupils, ataxia - vestibular dysfunction, cerebellar dysfunction
|
|
Q125. Thiamine (B1) Deficiency - Patients
|
A125. Alcoholics; dialysis; hyperemesis; starvation; cancer; AIDS; can be triggered by large-dose glucose admin if deficient
|
|
Q126. Thiamine (B1) Deficiency - Tx
|
A126. Reversible almost immediately with thiamine admin
|
|
Q127. Korsakoff's Psychosis - What is it
|
A127. Late complication of untreated patients with Wernicke's; can be triggered by severe or repeated DTs; can be triggered by SAH and thalamic injuries; immediate memory affected; confabulation
|
|
Q128. Korsakoff's Psychosis - Tx
|
A128. Prognosis good - head injury and SAH; irreversible - others
|
|
Q129. B12 deficiency - What are Signs/Sxs
|
A129. Subacute combined degeneration
|
|
Q130. B12 deficiency - Patients
|
A130. Patients with pernicious anemia
|
|
Q131. B12 deficiency - Tx
|
A131. B12 injections or large oral doses
|
|
Q132. Folate Deficiency - What are Signs/Sxs
|
A132. Irritability; glossitis; diarrhea; depression; neural tube defects
|
|
Q133. Folate Deficiency - Patients
|
A133. Alcoholics – alcohol interferes with absorption; Patients with pernicious anemia
|
|
Q134. Folate Deficiency - Tx
|
A134. Reversible if corrected early
|
|
Q135. Seizures - General Evaluation
|
A135. Epilepsy - seizure disorder, 2+ seizures not related to reversible stressors; was seizure epileptic – History, increased prolactin = epileptic VITAMINS - seizure caused by; vascular; infection; trauma; autoimmune; metabolic; idiopathic; neoplasm; sychiatric (faking it); 1st seizure not treated when underlying cause unknown
|
|
Q136. Partial Seizures - What are they
|
A136. Arise from focus; limited to one side; consciousness usually not lost; simple partial & complex part; can progress to generalized
|
|
Q137. Partial Seizures - History/PE
|
A137. Simple partial - consciousness not impaired; motor - Jacksonian march; sensory - parietal; autonomic - BP, HR, PVR; psychic - fear, deja vu; postictally - Todd's paralysis; resolves in 1-2 days Complex partial - consciousness impaired; temporal lobe: auditory or visual hallucination, déjà vu, automatisms; postictal – confusion, amnesia
|
|
Q138. Partial Seizures - Workup
|
A138. EEG; rule out systemic causes – CBC, electrolytes, Ca2+, fasting glucose, LFTs, tox screen, RPR, renal panel, ESR; rule out mass - MRI or CT with contrast
|
|
Q139. Partial Seizures - Tx
|
A139. Tx underlying cause; recurrent partial – phenytoin, oxcarbazepine, tegretol, phenobarbital, valproic acid; kids - phenobarbital; intractable temporal lobe - WADA testing, anterior temporal lobectomy
|
|
Q140. Generalized Seizures - What are they
|
A140. Begin diffusely throughout both sides; consciousness always lost; postictal confusion; most common types - tonic-clonic (grand mal), absence (petit mal)
|
|
Q141. Tonic-Clonic Seizures - History/PE
|
A141. Start suddenly with tonic extension of back and extremities; repetitive symmetric clonic movements; incontinence; tongue biting; may look cyanotic; consciousness slowly regained; may complain of - muscle ache, headache
|
|
Q142. Tonic-Clonic Seizures - Tx
|
A142. Tx underlying cause; idiopathic - valproate - 1st line; lamotrigine - adjunctive; topiramate - adjunctive; symptomatic - same therapy as partial seizure.
|
|
Q143. Absence (Petit Mal) Seizures-; What are they
|
A143. Begin in childhood; subside before adulthood; often familial
|
|
Q144. Absence (Petit Mal) Seizures-; History/PE
|
A144. Brief, often unnoticeable episodes of impaired consciousness; lasts 5-10 seconds; have 100's of times/day; amnestic during and immediately after eye flutters or lips smack; can be precipitated by hyperventilation
|
|
Q145. Absence (Petit Mal) Seizures-; Evaluation
|
A145. EEG - 3 Hz per sec. spike & wave discharges
|
|
Q146. Absence (Petit Mal) Seizures-; Tx
|
A146. Ethosuximide - 1st line; valproic acid; zonisamide
|
|
Q147. Infantile Spasms; (West Syndrome) - What is it; Tx
|
A147. Syndrome - infantile spasms (generalized seizures); symmetric, tonic, 5-10 at a time while drowsy or upon awakening; abnormal interictal EEG; arrest of psychomotor development at age of onset; starts at 3-12 months; usually male; MR; Tx – ACTH, prednisone, clonazepam, valproic acid
|
|
Q148. Status Epilepticus - What is it; Common Causes
|
A148. Brain in persistent state of Seizure; consistent seizure or recurrent without regaining consciousness > 30 min. med emergency - 20% mortality; common causes - anticonvulsive withdrawal/noncompliance, anoxic brain injury, alcohol withdrawal, metabolic disturbance (hypoNa+), trauma, infection; usual cause - subtherapeutic or noncompliance
|
|
Q149. Status Epilepticus - Evaluation
|
A149. Airway, breathing, circulation; labs – electrolytes, anticonvulsants; get History; look for etiology if no prior History (tumor, encephalitis, SAH); (EEG, CT only when stable)
|
|
Q150. Status Epilepticus - Tx
|
A150. Diazepam or lorazepam; if continues - phenytoin or fosphenytoin; if continues - phenobarbital; if continues - midazalom or propoful
|
|
Q151. Headache - Things to think about; (Evaluation)
|
A151. Headache new or old; characteristics; any associated Sxs; any neurological Sxs; SAH suspected?
|
|
Q152. Migraine Headache - What is it
|
A152. More commonly affects women and those with family History; vascular & 5HT abnorm; triggers – menses, OCP, chocolate, fasting, stress, bright lights
|
|
Q153. Migraine Headache - History/PE
|
A153. Throbbing > 2 hrs, usually lasts < 24 hrs; n/v; photophobia; sensitive to noise; "classic" migraine - visual aura precedes, unilat; "common" migraine - 80%, can be bilateral, periorbital
|
|
Q154. Migraine Headache - Dx
|
A154. History; if have focal neuro deficits - CT or MRI; Sxs acute in onset - rule out meningitis or SAH
|
|
Q155. Migraine Headache - Tx
|
A155. Avoid known triggers; aspirin/NSAIDs; sumatriptan; prophylaxis - beta-blockers, TCAs, Ca2+ channel blockers, valproic acid
|
|
Q156. Cluster Headache - What is it
|
A156. Men, ~ 25 y/o - age of onset
|
|
Q157. Cluster Headache - History/PE
|
A157. Unilateral, periorbital; 30 min. - 3 hrs. attacks in clusters - same part of head, same time of day, same time of year; can be precipitated by alcohol or vasodilators; ipsilateral tearing of eye
|
|
Q158. Cluster Headache - Dx
|
A158. History
|
|
Q159. Cluster Headache - Tx
|
A159. Acute therapy with high-flow O2 (100% nonrebreather O2); sumatriptan; corticosteroids; prophylaxis - Ca2+ channel blockers, valproic acid, methylsergide; prophylaxis important - by the time abortive meds take effect, has already resolved; methylsergine (sansert) - need drug holiday every several months to avoid risk of retroperitoneal fibrosis
|
|
Q160. Tension Headache - What is it
|
A160. MC type diagnosed in adults; chronic
|
|
Q161. Tension Headache - History/PE
|
A161. Tight, bandlike pain; occipital and neck; exacerbated by – noise, bright lights, stress, fatigue
|
|
Q162. Tension Headache - Dx
|
A162. Dx of exclusion
|
|
Q163. Tension Headache - Tx
|
A163. Avoid exacerbating factors; NSAIDs - 1st line; prophylaxis - Ca2+ channel blockers; alpha blockers; TCAs
|
|
Q164. Benign Paroxysmal; Positional Vertigo - What is it
|
A164. Peripheral vertigo; otoliths dislodge from usual position; migrate over time into semicircular canals; abnorm fluid displacement => vertigo
|
|
Q165. Benign Paroxysmal; Positional Vertigo - History/PE
|
A165. Sudden onset of severe vertigo and nystagmus; vertigo with head movement in direction of affected ear; happens turning head in bed; 5 sec. - 1 min. n/v; Sxs decreased with repetitive tests; usually history of recent trauma
|
|
Q166. Benign Paroxysmal; Positional Vertigo - Dx
|
A166. Nylen-Barany Maneuver; (Dix-Hallpike)
|
|
Q167. Benign Paroxysmal; Positional Vertigo - Tx
|
A167. Usually subsides spontaneously in weeks to months; Epley Repositioning Maneuver
|
|
Q168. Meniere's Disease; (Endolymphatic Hydrops) - What is it
|
A168. Peripheral vertigo from buildup of endolymphatic fluid in inner ear = V and P change; risk factors - head trauma, syphilis
|
|
Q169. Meniere's Disease; (Endolymphatic Hydrops) - History/PE
|
A169. Sudden attacks of vertigo; lasts up to 24 hours; attacks can last hours to days; n/v; ear fullness; tinnitus; hearing loss; significant permanent hearing loss; can occur over period of years
|
|
Q170. Meniere's Disease; (Endolymphatic Hydrops) - Dx
|
A170. Audiometry - low-freq. pure tone hearing loss
|
|
Q171. Meniere's Disease; (Endolymphatic Hydrops) - Tx
|
A171. Low-salt diet; acetazolamide; acute – antihistamines, antiemetics, benzos; if refractory - surgical decompression
|
|
Q172. Deep Fibular Nerve
|
A172. FOOT DROP, paresthesia in webspace between big toe and second toe
|
|
Q173. Femoral Nerve
|
A173. (from posterior division of L2, L3, L4); longest branch is saphenous nerve - sensation over area of great saphenous vein;; impaired ability to flex at hip and extend knee;; decreased patellar reflex
|
|
Q174. Superior Gluteal Nerve
|
A174. (L4, L5, S1 - exits via greater sciatic foramen above piriformis); innervates gluteus medius, minimus and tensor fascia latae;; impaired hip abduction,; in walking - "Trendlenburg" gait: pelvic tilt (sag) toward opposite side form lesion
|
|
Q175. Inferior Gluteal Nerve
|
A175. (L5-S2; gluteus maximus - exits greater sciatic foramen below piriformis w/ pudendal and sciatic); impaired lateral rotation and extension of thigh at hip, DIFFICULTY GETTING UP FROM A CHAIR, gluteus minimus gait = thrust torso posteriorly
|
|
Q176. Superficial Fibular Nerve
|
A176. impaired eversion and dorsal sensation, but extension is intact
|
|
Q177. Tibial Nerve
|
A177. "tarsal tunnel syndrome"; decreased flexion of big toe, difficulty standing on tiptoe
|
|
Q178. Obdurator Nerve
|
A178. (L2-4, anterior division, medial thigh-adductors- exits via obdurator canal); impaired adduction of thigh at hips
|
|
Q179. Terrible triad
|
A179. anterior cruciate ligament; medial collateral ligament; medial meniscus
|
|
Q180. Anterior drawer sign
|
A180. tibia displaced anteriorly to femur in flexed knee; indicated ACL tear
|
|
Q181. Sx of torn Medial collateral ligament
|
A181. pain when leg is rotated medially at the knee; (abnormal passive abduction)
|
|
Q182. Foot drop (loss of dorsiflexion)
|
A182. tibialis anterior; Common peroneal nerve (L4-S2); (PED: Peroneal Everts and Dorsiflexes)
|
|
Q183. Loss of plantar flexion
|
A183. gastroc and soleus; Tibial N (L4-S3); TIP: Tibial Inverts and Plantarflexes (if injured, can't stand on TIPtoes)
|
|
Q184. Loss of knee jerk
|
A184. Femoral Nerve; L2,3,4
|
|
Q185. Loss of hip adduction
|
A185. Obdurator (L2,3,4)
|
|
Q186. Vertebral disk herniation usu occurs between which vertebrae?
|
A186. between L5 and S1; Sciatica!
|
|
Q187. Lumbar puncture pierces which structures?
|
A187. SLEDsA to CSF; Skin/superficial fascia; Ligaments (supraspinous, interspinous and ligmentum flavum if puncture is off midline); Epidural space and intralaminal space; Dura mater; subdural potential space; Arachnoid; CSF is in the subarachnoid space
|
|
Q188. Which nerve extends the knee?
|
A188. femoral
|
|
Q189. Which nerve flexes the knee?
|
A189. Tibial
|
|
Q190. Nerves that contain fibers from the superior rami of the plexus (L2-L4) innervate muscles in the
|
A190. anterior compartment; (that act at the hip and knee joint).
|
|
Q191. Nerves that contain fibers from the inferior rami of the plexus (S1-S3) innervate muscles of
|
A191. the leg (that act on ankle and foot joints)
|
|
Q192. Dermatome paresthesia at the anterior thigh
|
A192. L3
|
|
Q193. Dermatone paresthesia at the medial leg
|
A193. L4
|
|
Q194. Dermatome paresthesia at the anterior leg and dorsum of foot
|
A194. L5
|
|
Q195. Dermatome paresthesia at the lateral foot and sole
|
A195. S1
|
|
Q196. Patellar tendon reflex
|
A196. L4
|
|
Q197. Achilles tendon reflex
|
A197. S1
|
|
Q198. Obturator nerve comes from
|
A198. L2-L4 (anterior division)
|
|
Q199. Femoral
|
A199. L2-L4 (posterior division)
|
|
Q200. Common Fibular comes from roots
|
A200. L4 L5 S1 S2 (posterior division)
|
|
Q201. Tibial nerve comes from roots
|
A201. L4 L5 S1-S3 (anterior division)
|
|
Q202. Motor weakness with obturator lesion
|
A202. adduction of thigh; (affected hip flexors and hip adductors)
|
|
Q203. motor weakness with femoral lesion
|
A203. extension of knee
|
|
Q204. motor weakness with common fibular lesion
|
A204. foot drop; (dorsiflexion, foot eversion)
|
|
Q205. motor weakness with tibial lesion
|
A205. no plantar flexion or toe flexion
|
|
Q206. Pregnancy can cause compression of
|
A206. L3/obturator
|
|
Q207. Psoas abscess can cause a lesion of
|
A207. Femoral
|
|
Q208. Common (4) injuries to the Common Fibular nerve
|
A208. 1) compression at fibula neck; 2) hip fracture or dislocation; 3) misplaced gluteal injection; 4) piriformis syndrome
|
|
Q209. Penetrating trauma to buttock or hip fracture/dislocation can cause nerve damage to
|
A209. Common fibular or tibial
|
|
Q210. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
|
A210. stroke
|
|
Q211. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
|
A211. cerebral infarct or ischemic stroke
|
|
Q212. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
|
A212. HEMORRHAGIC STROKE
|
|
Q213. cause of ischemic stroke
|
A213. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
|
|
Q214. type of hemmorage?; site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
|
A214. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
|
|
Q215. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
|
A215. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
|
|
Q216. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
|
A216. SUBARACHNOID HEMORRHAGES (SAH)
|
|
Q217. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
|
A217. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
|
|
Q218. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis
|
A218. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
|
|
Q219. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
|
A219. ACUTE EFFECTS OF SEVERE HYPERTENSION
|
|
Q220. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
|
A220. subdural hematoma
|
|
Q221. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
|
A221. epidural hematoma
|
|
Q222. type of Blunt Head injury?; clinical features: TRANSIENT LOC (level of conciousnes); characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY/damage = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
|
A222. CONCUSSION
|
|
Q223. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
|
A223. CONTUSION
|
|
Q224. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
|
A224. stroke
|
|
Q225. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
|
A225. cerebral infarct or ischemic stroke
|
|
Q226. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
|
A226. HEMORRHAGIC STROKE
|
|
Q227. cause of ischemic stroke
|
A227. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
|
|
Q228. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
|
A228. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
|
|
Q229. Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
|
A229. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
|
|
Q230. site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
|
A230. SUBARACHNOID HEMORRHAGES (SAH)
|
|
Q231. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
|
A231. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
|
|
Q232. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolarsclerosis
|
A232. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
|
|
Q233. AN ACUTE NEUROLOGIC DYSFUNCTION OCCURRING AS A RESULT OF A VASCULAR PROCESS
|
A233. stroke
|
|
Q234. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
|
A234. ACUTE EFFECTS OF SEVERE HYPERTENSION
|
|
Q235. Type of stroke?; focal ischemic necrosis of brain tissue due to occlusive vascular disease or other forms of vascular insufficiency
|
A235. cerebral infarct or ischemic stroke
|
|
Q236. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
|
A236. subdural hematoma
|
|
Q237. Type of stroke?; BRAIN DAMAGE DUE TO SPONTANEOUS RUPTURE OF; BLOOD VESSEL
|
A237. HEMORRHAGIC STROKE
|
|
Q238. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
|
A238. epidural hematoma
|
|
Q239. cause of ischemic stroke
|
A239. occlusion of an artery, usually by:; 1. THROMBOEMBOLUS; 2. ATHEROSCLEROTIC PLAQUE (stenosis, sudden occlusion); extracranial vs. intracranial vascular lesions
|
|
Q240. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
|
A240. CONCUSSION
|
|
Q241. site: basal ganglia, thalamus, pons, deep; cerebellum; usual cause: hypertensive vascular disease; outcome: often lethal
|
A241. INTRAPARENCHYMAL HEMORRHAGES (IPH): ganglionic
|
|
Q242. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
|
A242. CONTUSION
|
|
Q243. type of hemorrhage?; Site: cerebral lobes; usual cause: various (malformation, coagulopathy. etc.); outcome: variable
|
A243. INTRAPARENCHYMAL HEMORRHAGES (IPH) : lobar
|
|
Q244. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID
|
A244. LACERATION
|
|
Q245. type of hemorrhage?; site: base of brain,; convexities; usual cause: berry aneurysm, AVM; outcome: often lethal, acute; vasospasm, chronic; hydrocephalus
|
A245. SUBARACHNOID HEMORRHAGES (SAH)
|
|
Q246. hippocampus: Sommer's sector (area CA1); cerebral cortex: laminar necrosis watershed zones; cerebellum: Purkinje cells
|
A246. pattern of DIFFUSE HYPOXIC/ISCHEMIC ENCEPHALOPATHY
|
|
Q247. – acceleration of large-vessel atherosclerosis; arteriosclerosis, especially in basal ganglia, thalamus, pons,; cerebellum, deep white matter; formation of Charcot-Bouchard aneurysms; arteriolosclerosis
|
A247. CHRONIC HYPERTENSIVE CEREBROVASCULAR PATHOLOGY
|
|
Q248. – hyperplastic arteriolosclerosis ("onion skinning"); necrotizing arteriolitis (fibrinoid necrosis)
|
A248. ACUTE EFFECTS OF SEVERE HYPERTENSION
|
|
Q249. Hematoma?; source: bridging veins; clinical feature: acute subacute chronic; causes: trauma can be mild;; brain atrophy, coagulopathy
|
A249. subdural hematoma
|
|
Q250. source: dural arteries; Hematoma?; clinical feature: LOC, then “silent (lucid)” interval; causes: skull fracture
|
A250. epidural hematoma
|
|
Q251. type of Blunt Head injury?; clinical features: TRANSIENT LOC; characteristic: ? MILD DAD = DIFFUSE AXONAL INJURY = axonal spheroids (swellings) form at the torn end of the axon in white matter tracts and appear as eosinophilic globules in H&E
|
A251. CONCUSSION
|
|
Q252. type of Blunt Head injury?; clinical features: LOC +/- DEFICITS; characteristic: INTACT PIA-ARACHNOID, FRONTAL/TEMPORAL POLES, LATERAL TEMPORAL
|
A252. CONTUSION
|
|
Q253. type of Blunt Head injury?; clinical features: LOC + DEFICITS; characteristic: TORN PIA-ARACHNOID
|
A253. LACERATION
|
|
Q254. type of blunt head injury?; clinical feature: PROLONGED LOC; characteristic: TEARING OF AXONS (SPHEROIDS) IN CORPUS; CALLOSUM, LONG TRACTS
|
A254. Diffuse axonal damage
|
|
Q255. PENETRATION OF BRAIN OR SPINAL CORD BY PROJECTILE OR OTHER MOVING OBJECT; (bullet, knife blade, etc.); AMOUNT OF DAMAGE DEPENDS ON MASS, SHAPE, AND VELOCITY OF MISSILE
|
A255. MISSILE HEAD INJURY
|
|
Q256. type of MISSILE HEAD INJURY?; missile produces depressed fracture but does not enter skull
|
A256. DEPRESSED
|
|
Q257. type of MISSILE HEAD INJURY?; missile enters cranial cavity
|
A257. PENETRATING
|
|
Q258. type of MISSILE HEAD INJURY?; missile enters and exits cranial cavity
|
A258. PERFORATING
|
|
Q259. type of stroke?; obstruction of a feeding blood vessel or a significant reduction in blood flow
|
A259. Ischemic
|
|
Q260. type of stroke?; rupture of a blood vessel into or around the brain
|
A260. Hemorrhagic
|
|
Q261. 8 signs and symptoms of stroke
|
A261. Sudden onset (usually maximum within 10 seconds); Weakness of one side of the body / face; Numbness / tingling of one side of the body or face; Incoordination / clumsiness of one side of the body, falling to one side, spinning sensation; Sudden change in speech or language; Loss of vision, especially in one eye on or one side, Double vision; Acute confusion; Sudden, severe headache
|
|
Q262. acute stroke management
|
A262. Evaluation and stabilization of patient: Vitals, cardiovascular, neurological assessment, O2 NC, HLIV x2; Diagnostic work-up begun: Labs, brain imaging (CT, MRI); Consider “clot-buster”: t-PA therapy (call Stroke Team); **must tx pt with in 60 min arrive
|
|
Q263. focused stroke history, 11 risk factors
|
A263. High blood pressure (hypertension); "High sugar" (diabetes); Heart disease, heart attacks, irregular heart beats; High cholesterol; Smoking, alcohol use, illegal drugs; No regular physical exercise; Family history of stroke; Previous stroke; Sickle-cell disease
|
|
Q264. 5 focal symptoms for focused stroke history
|
A264. Change or loss of vision (one eye? both eyes?); Numbness, tingling, weakness, clumsiness, heaviness of one side of the body; Change or loss of language (understanding, comprehension, reading, writing); Change or loss of steady walking, imbalance, falling; Headache (location, type, severity, duration)
|
|
Q265. focused neurological findings in focused stroke history and physical
|
A265. Level of consciousness (alert, lethargic / drowsy, stupor, coma); Language (comprehension, fluency, repetition, naming, reading, writing); Visual fields and eye movements (other CN); Strength (face, arms, legs, drift) and reflexes; Coordination (gait, finger to nose, heel to shin); Sensation (pinprick, temperature, joint position sense / vibration)
|
|
Q266. t-PA criteria
|
A266. Inclusion criteria: Age ≥ 18, Ischemic stroke with measurable deficit, < 3 hr since symptom onset (time of onset is critical); Clock starts when patient last seen normal; Many exclusions, but patients meeting the above criteria should be considered for thrombolytic treatment
|
|
Q267. These are complications for what neurologic condition?; Seizures; Cardiovascular (MI, arrhythmia, sudden death); Respiratory (aspiration pneumonia, DVT / PE); Endocrine (hyperglycemia, hyponatremia); Urinary tract infection; Decubitus ulcers; Psychological / Psychiatric; Depression (40%); Confusion / combativeness / hallucinations; Abulia
|
A267. stroke
|
|
Q268. Carotid Endarterectomy
|
A268. Symptomatic: NNT = 6; Asymptomatic: NNT = 100; 90% > 80% > 70% > 60% stenosis; Benefit regardless of age, but older > younger; Ulcerated plaque; Hemispheric TIA / stroke (vs. retinal); Men> women; Associated stroke risk factors: Hypertension, diabetes, tobacco, lipids
|
|
Q269. Carotid Angioplasty and Stenting
|
A269. Increasingly used, with only one RCT showing efficacy / equivalence to CEA (3 stopped early); Multiple trials underway (carotid disease); FDA approved only for high-risk patients with symptomatic high-grade stenosis; With few exceptions, vertebrobasilar and intracranial stenting should be limited to RCTs; As with CEA, ask about complication rates
|
|
Q270. neurocutaneous disorder?; def: autosomal dominant disorder caused by; TSC gene mutation (chromosome 9: TSC1, hamartin;; chromosome 16: TSC2, tuberin); INCIDENCE: 1 in 29,000 births; CLINICAL FEATURES: Seizures/infantile spasms, Mental retardation, Behavioral abnormalities, Neoplastic and non- neoplastic tumors (cerebral tubers, retinal tumors, cardiac rhabdomyomas, renal tumors), Cutaneous lesions (ash leaf spots, facial angiofibromas, etc.)
|
A270. tuberous sclerosis
|
|
Q271. neurocutaneous syndrome?; Facial angiomas involving V1 and rarely V2 /V3 distribution. Underlying venous pial angiomatosis causing seizures, hemiparesis hemianopsia, mental deterioration.
|
A271. Sturge Weber Syndrome
|
|
Q272. areas that are sensitive to hypoxic ischemic encephalopathy in a term infant
|
A272. parasagittal, ulegyria (selective loss of cortex in depth of sulci), thalamus, BG and brainstem
|
|
Q273. where are the following tumors located and what age group are they associated with?; astrocytomas / glioblatomas; metastatic carcinomas; menigiomas; lymphomas; pituitary adenomas
|
A273. location: cerebrum; age group : adults
|
|
Q274. where are the following tumors located and what age group are they associated with?; metastaic carcinomas; menigiomas; schwannomas (cn VIII)
|
A274. location: posterior fosssa; age group: adults
|
|
Q275. where are the following tumors located and what age group are they associated with?; PNET; ependymonas; choroid plexus tumors; optic nerve gliomas; germ cell tumors; craniopharyngiomas
|
A275. location: cerebrum; age group: children
|
|
Q276. where are the following tumors located and what age group are they associated with?; PNET (cerebellar medulloblastoma); pilocytic astrocytomas; ependymomas; brainstem gliomas
|
A276. location: posterior fossa; age group: children
|
|
Q277. type of brain tumor?; A SLOWLY GROWING NEOPLASM OF ASTROCYTES TYPICALLY ARISING IN THE CEREBELLUM OF CHILDREN
|
A277. pilocytic astrocytoma, who grade 1
|
|
Q278. what are the locations for pilocytic astrocytoma, who grade 1 in children?
|
A278. cerebellum, optic nerve,; hypothalamus
|
|
Q279. what are the locations for pilocytic astrocytoma, who grade 1 in adults?
|
A279. adults: less common but usually occur in; cerebrum, spinal cord
|
|
Q280. what brain tumor has the following features?; mostly solid growth pattern, often cystic; slowly growing; indolent clinical behavior; do not progress in grade over time
|
A280. pilocytic astrocytoma, grade 1
|
|
Q281. tumor composed of cells resembling oligodendrocytes
|
A281. OLIGODENDROGLIOMA, GRADE 2
|
|
Q282. location of OLIGODENDROGLIOMA, WHO GRADE 2
|
A282. cerebral hemispheres
|
|
Q283. what brain tumor has the following features?; often slow-growing; infiltrative or solid; often contain calcifications; often associated with epilepsy; may have anaplastic form (WHO grade 3)
|
A283. OLIGODENDROGLIOMA, GRADE 2
|
|
Q284. NEOPLASMS DERIVED FROM VENTRICULAR LINING CELLS
|
A284. ependymomas and choroid plexus tumors
|
|
Q285. what brain tumor presents as follows?; MASS EFFECT, OBSTRUCTIVE HYDROCEPHALUS
|
A285. ependymomas and choroid plexus tumors
|
|
Q286. for ependymomas (grade 2 or 3), what is the location for:; 1. children; 2. adults
|
A286. 1. lateral and fourth ventricles; 2. fourth ventricle, spinal cord
|
|
Q287. for papillomas(grade 1), what is the location for:; 1. children; 2. adults
|
A287. 1. lateral or fourth ventricles; 2. fourth ventricle
|
|
Q288. Astrocytoma
|
A288. Low grade (2) glial tumor; More common in cerebral hemisphere in adults; Hits the brainstem of kids; special: Infiltrative; Progress to malignancy increases with age. 5 year survival rate; Astrocytomas can be stained with GFAP
|
|
Q289. Glioblastoma
|
A289. High grade glial tumor; They are more invasive and divide more rapidly than astrocytomas; special: Necrosis with Pseudopalisading; Survival is less than 1 year; Most common primary brain tumor.
|
|
Q290. Pilocytic Astrocytoma
|
A290. Grade 1; Slow growing, benign glial tumor of kids Does not progress to a later grade; special: Optic Nerve, cerebellum and hypothamus are affected
|
|
Q291. Oligodendroglioma
|
A291. Grade 2; Tumor of Oligodendrocytes; Affects Adults only; Milk and Eggs-fried egg appearance with calcifications. special: Calcifications, Epilepsy, Rare and slow growing
|
|
Q292. Ependymoma
|
A292. Neoplasm derived from lining of the ventricles. Low grade (II); Kids-lateral and 4th ventricles; special: May lead to hydrocephalus and has a poor prognosis. Characteristic perivascular pseudorosettes. Adults-4th and spinal cord
|
|
Q293. Choroid Plexus tumors
|
A293. Papillomas are the benign form; Carcinomas are the malignant form; Tumors mimic normal choroid and may overproduce CSF. special: Papillomas in kids-lateral and 4th; Adults-4th; Carcinomas are only in kids., Lateral ventricle. Rosettes
|
|
Q294. Embryonal Tumors; Primitive Neuroectodermal Tumors
|
A294. Embryonic Tumor; Retinoblastoma; Medulloblastoma-affects cerebellum. PNET-Cerebral Hemispheres; special: These tumors are highly metastatic, May disseminate thru the CSF; Often associated with gentic defects; Rosettes
|
|
Q295. Medulloblastoma
|
A295. Most common Embryonic tumor. Arises in the cerebellum; Dissemination into the subarachnoid space is common. special: These are very fast growing tumors, folks. Five year survival rate is 50%. Symptoms typically result from blockage of the 4th ventricle which leads to hydrocephalus.
|
|
Q296. Meningioma
|
A296. Non neuroectodermal tumor; Second most common brain tumor; Adults: Arises from arachnoid cells; Benign but mass effect causes troubles. Special: Resectable; Psammoma Bodies-calcifications commonly found in meningiomas
|
|
Q297. Schwannoma
|
A297. Arises from Schwann Cell; Often localized to the 8th nerve, causing an acoustic schwannoma-leads to unilateral hearing loss and vertigo; Adults; special: Bilateral form found in Neurofibromatosis 2
|
|
Q298. Mass effect
|
A298. Damage to the brain due the bulk of a tumor, the blockage of fluid, or excess accumulation of fluid within the skull. Mass effect often presents as seizures and dementia.
|
|
Q299. most likely brain tumor in children
|
A299. cerebellar tumors of the posterior fossa
|
|
Q300. most likely brain tumors in adults
|
A300. Adults are more likely to get tumors of the cerebral hemispheres. These include astrocytomas, meningiomas and metastases
|
|
Q301. Low grade, may cause endocrine dysfunction. Derived from Rathkes pouch
|
A301. Pituitary Adenoma - a sellar tumor
|
|
Q302. Low-grade but locally aggressive epithelial tumor; Derived from Rathke’s pouch
|
A302. Craniopharyngioma
|
|
Q303. 20-30% of all brain tumors, with greater incidence in older people, and about 85% are multiple within the CNS. Sources: lung, breast, malignant melanoma, kidney, GI tract, others; Path: solid or cystic circumscribed mass with central necrosis and prominent vasogenic edema
|
A303. Secondary Tumors – Metastatic cancer
|
|
Q304. Diffuse tumor cell spread through the CSF pathways, often associated with high CSF protein, hydrocephalus, involvement of multiple cranial and spinal nerve roots
|
A304. Leptomeningeal carcinomatosis
|
|
Q305. Acute infection in Subarachnoid space caused by virulent bac, fungi, some protozoans
|
A305. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
|
|
Q306. Acute inflam in SAS: examine CSF; ↑ pressure (200-500 mmH2O), ↑ protein (>50mg/dl), ↓ glucose (often<40mg/dl); leukoctosis (mostly PMNs); organism may be detectable by Gram stain, culture; spectrum of organisms varies w/age & clinical circumstances, commonly includes:; bac: strep, staph, hemophilus, neisseria, gram (–) rods, listeria, anaerobes; fungi: immunosuppresed: aspergillus, candida, mucor; environmental exposure: coccidoides, histoplasma; other: toxoplasma, ameba; pathogenic sequence: 10 colonization/infection in body; dissemination to CNS (usu hematogenous), infect meninges; acute inflammatory response in SAS; brain swelling, damage, outcome dissemination; inflam/overall response to infection may be modified by pt’s immune status, virulence of organism, effects of tx
|
A306. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
|
|
Q307. CNS infection?; Systemic: fever, n/v, irritability, lethargy; Meningismus: nuchal rigidity, Brudzinski sign flexion hip, knee), Kernig sign (starting from flexed (passive flexion neck knee/thigh, extension of knee resisted); Direct CNS involvement: headache, photophobia, altered consciousness, seizures, focal localizing signs
|
A307. Acute Purulent Leptomeningitis; (pyogenic, bacterial)
|
|
Q308. CNS infection?; CSF findings: ↑ protein (mild), normal glucose, leukocytosis (very early: few PMNs, later: mostly lymphocytes); viral: common, includes common viruses causing URI or upper GI infections; some less virulent bacteria/other agents; non-infectious agents (cancer cells=leptomeningeal carcinomatosis,; chemicals/drugs=chemical meningitis) can produce similar syndrome
|
A308. Acute Lymphocytic Meningitis; (viral, “aseptic”)
|
|
Q309. Acute, usually self-limiting viral infection in SAS, characterized by lymphocytic inflammation
|
A309. Acute Lymphocytic Meningitis; (viral, “aseptic”)
|
|
Q310. CNS infection?; Fever, headache, signs of meningeal irritation, lethary, rash (milder than acute purulent leptomeningitis, and usu does not significantly alter consciousness)
|
A310. Acute Lymphocytic Meningitis; (viral, “aseptic”)
|
|
Q311. CNS infection?; CSF findings:; ↑ pressure or CSF blockage, ↑ protein (100-200mg/dl, higher w/CSF blockage), ↓ glucose (less than in acute purulent), leukoctosis (lymphocytes, monocytes); agent (organism, tumor cell) may be detectable; commonly “basal meningitis” w/mononuclear inflammation, fibrosis, +/- granulomas (depends on agent), most prominent at base of brain; progressive meningeal, fibrosis, -chronic inflammation in SAS hydrocephalus (non-obstructive), ↑ ICP, vasculitis, root/parenchymal involvement infarcts, focal deficits, cognitive decline
|
A311. Chronic Meningitis
|
|
Q312. Chronic inflammation in leptomeninges due to relatively indolent, persistent agent (TB, syphilis, sarcoidosis, some low-grade tumors, foreign substances)
|
A312. Chronic Meningitis
|
|
Q313. CNS infection?; often non-specific/non-localizing, slowly evolving (+/- heachache, +/- stiff neck, low grade fever, seizures, cognitive dysfunction)
|
A313. Chronic Meningitis
|
|
Q314. CNS infection?; predisposing factors: infection elsewhere (osteomyelitis, dental, sinusitis, otitis media, endocarditis, congenital heart disease), trauma skull/spine (including surgery), foreign body (catheter, gauze, bullet); bacteria, fungi, others; localized area of tissue damage & acute/chronic inflam surrounded by reactive layer; brain parenchyma may show prominent edema; Complications:; mass effect(↑ ICP, herniation; abscess rupture into ventricles or disseminate in SAS as acute purulent leptomen. infection spread to other organs or systemic (sepsis); focal permanent neurologic deficits
|
A314. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
|
|
Q315. Acute/chronic localized purulent or necrotizing infections due to destructive bacteria, fungi, or other organisms
|
A315. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
|
|
Q316. CNS infection?; Infec/inflam: Fever, malaise; Mass effects: headache, ↑ICP; Localizing signs, if brain parenchyma is involved: ex. seizures, focal deficits
|
A316. Empyema & abscesses; 1. subdural/epidural empyema; 2. brain parenchymal abscess; (“cerebritis”)
|
|
Q317. CNS infection?; Acute viral infection of brain parenchyma +/- meninges
|
A317. Acute Viral Encephalitis
|
|
Q318. CNS infection?; agent: HSV 1; site of involvement: -medial temporal lobes (Cowdry type A nuclear viral inclusions)
|
A318. Acute (meningo)encephalitis; Acute necrotizing
|
|
Q319. CNS infection?; Progressive viral infection, w/prolonged incubation following initial exposure, insidious onset, slow progression of sx, due to conventional viral agents; *prions excluded here; Sx: slowly progressive dementia or loss of particular neurologic functions
|
A319. Chronic (slow) viral encephalitis
|
|
Q320. 1) Acute Lymphocytic meningitis – often during 10 infection; 2)Chronic HIV encephalitis w/ progressive dementia (AIDS dementia); 3)Vacuolar myelopathy – uncommon degeneration of posterior & lateral columns in spinal cord in chronic AIDS pt, resembles subacute combined degeneration seen in vitamin B12 deficiency; 4)peripheral neuropathy (various types); 5)inflammatory myopathy (polymyositis-like)
|
A320. HIV: syndromes
|
|
Q321. CNS infection?; agent: CMV; site of involvement:; periventricular tissues (cytomegalic cells); occurs as congenital infection (TORCH) & immunocompromised host
|
A321. Acute (meningo)encephalitis; Acute necrotizing
|
|
Q322. CNS infection?; agent?; HIV; involved site: brain atrophy, demyelination, encephalitis w/monocytes & giant cells
|
A322. AIDS Dementia
|
|
Q323. CNS infection?; agent:; papovirus JC strain); involved site:; infection, destruction oligodendrocytes -> progressive demyelination, usu in immunocompromised host
|
A323. PML(progressive multifocal leukoencephalopathy)
|
|
Q324. the removal, treatment, and return of (components of) blood plasma from blood circulation. separates things based on molecular weight.
|
A324. Plasmapheresis
|
|
Q325. autoimmune CNS disease?; auto-antibodies attack AchR; Weakness and Muscle Fatigue; Distribution of affected muscles is variable. **Eye muscles are the 1st thing involved. Reflexes and sensation is unaffected
|
A325. Myasthenia Gravis
|
|
Q326. Lab Tests for MG
|
A326. Anti AchR antibody is 85-90% positive.
|
|
Q327. can induce Myasthenia and antibodies to AchR
|
A327. Thymoma and Penicillamine can induce Myasthenia and antibodies to AchR. FYI: A thymoma is a tumor of the thymus gland that leads to an autoimmune response.
|
|
Q328. Treatment Myasthenia Gravis
|
A328. Plasmapheresis; Pyridostigmine blocks Ach Esterase which makes more Ach available. Thymectomy
|
|
Q329. Lambert-Eaton Syndrome
|
A329. Autoantibodies against the presynaptic voltage-gated calcium channels; caused by circulating antibodies to Voltage gated Calcium Channels which block Ach release. Clinical Features:; Weakness and fatigability; Autonomic Dysfunction-sexual dysfunction, dry mouth,; Reflexes are depressed; 60% of cases are associated with small cell lung cancer
|
|
Q330. Lab Tests for Lambert Eaton
|
A330. Antibody to Voltage Gated Calcium Channels
|
|
Q331. treatment for Lambert-Eaton Syndrome
|
A331. Search for and treat the tumor if it’s present (often paraneoplastic syndrome of small cell lung cancer); Pyridostigmine works, but is less effective than in Myasthenia gravis (MG). Plasmaphereisis works well too.
|
|
Q332. CNS autoimmune disease?; degenerations are disorders of the cerebellum, the part of the brain responsible for coordination, which are associated with tumors (neoplasms). They arise when tumors express proteins that are normally found only in neurons, and it is believed that the immune system, in its attempt to kill the tumor, also damages the cerebellum. current thought is that "killer T-cells", or cytotoxic CD8+ T lymphocytes, are the most likely mediator of neuronal injury.
|
A332. Paraneoplastic Syndromes
|
|
Q333. Examination of patients with anti-Purkinje cell antibodies, especially anti-Yo, is usually dominated by a rapidly progressive unsteadiness, and downbeating nystagmus.
|
A333. Paraneoplastic Syndromes
|
|
Q334. rare complication of cancer characterized by chaotic, synchronous eye movements (opsoclonus), spontaneous muscle jerks (myoclonus), and ataxia.
|
A334. Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
|
|
Q335. autoimmune disease in CNS?; almost exclusively associated with neuroblastoma
|
A335. children OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
|
|
Q336. autoimmune disease in CNS?; associated with small cell lung cancer (SCLC) and breast cancer are the most frequent tumors associated; It’s also known as dancing eye, dancing feet syndrome.
|
A336. adult OMS; Paraneoplastic opsoclonus-myoclonus syndrome (OMS)
|
|
Q337. Difficulty in finding works (dysnomia); Impaired visuospatial memory (misplace things ,not finding their way home); Impaired recent memory. Delusion ,insomnia, depression
|
A337. early sx of alzheimer's disease
|
|
Q338. Increasingly impaired remote memory; Non confluent speech; Agitation, aggression
|
A338. later sx of alzheimer's disease
|
|
Q339. Recent and remote memory obliterated; Mute; Severe rigidity
|
A339. final stage of alzheimer's disease
|
|
Q340. What disease has the following MRI features?; Marked reduction in brain volume; Cortical atrophy, frontal ,parietal; Ventricular dilatation (hydroceplus ex vacuo )
|
A340. alzheimer's disease
|
|
Q341. what disease is associated with the following?; Positron emission tomography (PET) : (fluorodeoxyglucose); Early changes: impaired glucose utilization in posterior cingulate gyrus and parietal cortex (cf. DLBD: anterior cingulate gyrus )
|
A341. alzheimer's disease
|
|
Q342. What disease has the following?; Key Pathological makers:; 1. Neurofibrillary tangles, Flame shaped; globose; 2. Senile plaques, diffuse, primitive, mature and burnt-out
|
A342. alzheimer's disease
|
|
Q343. What is the AD pathlogic criteria for the following ages?; < 50 years; 52-65 years; 66-75 years; 75 years & over
|
A343. < 50 years = 5 or more senile plaques per 200 x field. 52-65 years = 8 or more; 66-75 years = 10 or more; 75 years & over = 15 or more
|
|
Q344. What disease has the following pathogenic mechanism?; B-secretase and G-secretase cleave APP (amyloid protien) to form A-beta with 1-40 (accum. in vessel walls) or 1-42 (accum. in neurons); change in amyloid protien leads to alteration in 2nd and 3rd structure of normal protein
|
A344. Alzheimer's disease
|
|
Q345. what chromosomes are associated with the following AD genetic cases?; presenilin 1:; presenilin 2:; amyloid precursor protein (APP);; associated with late onset AD (sporadic).
|
A345. - presenilin 1: Chromosome 14; presenilin 2: Chromosome 1; amyloid precursor protein (APP); Chromosome 21; Apo-E ε 4 allele associated with late onset AD (sporadic).
|
|
Q346. what disease has the following sx?; changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating, and pain.
|
A346. MS
|
|
Q347. What disease requires the following for dx?; Clinical history and examination; Multiple CNS lesions in time and space; CSF examination: mild pleocytosis (5-50 lymphs) during acute attack, increased protein with high IgG, oligoclonal bands (persistent); MRI shows multiple plaques, active plaques; may enhance
|
A347. MS
|
|
Q348. what disease has the following common manifestations?; Optic neuritis: visual loss; Limb weakness; Sensory symptoms (paresthesias, hypesthesia); Cerebellar ataxia; Nystagmus; Diplopia (CN VI palsy or INO)
|
A348. MS
|
|
Q349. what disease presents as follows?; Age 15-50, but most cases start in the 20’s; Women are effected 2 times more than men; Optic Neuritis; Limb weakness which often presents as difficulty walking down stairs; Imbalance
|
A349. MS
|
|
Q350. what disease has the following?; CSF examination: Mild pleocytosis (increase in cell count) during an acuteü attack, Increased IgG); Oligoclonal Bands-due to high Ig levels on electrophoresis.
|
A350. MS
|
|
Q351. what drug used to tx MS are thought to interfere with INF Gamma which enhances attacks?
|
A351. INTERFERONs
|
|
Q352. what drug used to tx MS is a synthetic medication made of four amino acids that are found in myelin? This drug stimulates T cells in the body's immune system to change from harmful, pro-inflammatory agents to beneficial, anti- inflammatory agents that work to reduce inflammation at lesion sites.
|
A352. GLATIRAMER ACETATE: (trade name Copaxone)
|
|
Q353. what drug has been approved by the USA´s FDA for secondary progressive, progressive-relapsing, and worsening relapsing-remitting MS?
|
A353. MITOXANTRONE: (trade name Novantrone)
|
|
Q354. what drug used for MS is used to reduce the occurrence of clinical exacerbations. It is recombinant IgG directed against Alpha Integrin. Alpha Integrin inhibition prevents the inflammatory response?
|
A354. NATALIZUMAB: (trade name Tysabri)
|
|
Q355. what are 2 epidemiologic factors associated with MS
|
A355. -MS incidence increases with latitude. Prior to age 15, risk is correlated with geographic location.
|
|
Q356. CNS disease?; characterized by a brief but intense attack (punctate) of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. It often follows viral infection, or less often, vaccination for measles, mumps, or rubella. The symptoms come on quickly, beginning with encephalitis-like symptoms such as fever, fatigue, headache, nausea and vomiting, and in severe cases, seizures and coma.
|
A356. Acute disseminated encephalomyelitis (ADEM)
|
|
Q357. what CNS disease has the following pathology?; Multiple focal areas of small perivascular areas of demyelination and inflammation in white matter
|
A357. Acute disseminated encephalomyelitis (ADEM); **be able to distiguish from Leukodystrophy and MS
|
|
Q358. CNS disease?; Rare inherited disease which manifest as damage to myelin. Most have an early onset, are progressive and lethal. The majority are Autosomal Recessive. bilateral, symetric, and diffuse
|
A358. Leukodystrophy; **be able to distiguish from ADME and MS
|
|
Q359. CNS disease?; Caused by mutations or conformational changes of the prion-protein (PrPSC) or glycated PrPSC
|
A359. prion disorders
|
|
Q360. Formation of vacuoles in neural cytoplasm and nuclei. The size of the vacuole varies in the different sporadic forms. The vacuoles harbor the abnormal PrPSC-protein.
|
A360. Spongiform Degeneration:
|
|
Q361. type of amyloid plaque?; characteristic of the cerebellar form of sporadic CJD
|
A361. Kuru-plaques
|
|
Q362. type of amyloid plaque?; seen in the human form of bovine spongiform encephalopathy.
|
A362. Cortical amyloid plaques
|
|
Q363. prion disorder?; 85% of all cases (annually 1 per 1 milj) . Peak age of onset 60 – 65 years; Usually rapidly progressive dementia 4 -12 mo . With myoclonus, periodic sharp-wave EEG.
|
A363. Sporadic Creutzfeldt-Jakob disease
|
|
Q364. type of prion disease?; all defined by genotype at codon 129 of the prion gene. Differences in the methionine / valine polymorphism of this site and degree of protease resistance of conformationally changed protein do determine the type ,i.e., clinical symptoms and distribution of; pathology.
|
A364. Sporadic Creutzfeldt-Jakob disease
|
|
Q365. all cases occur with an autosomal dominant mode of inheritance. Twenty different mutations of the PrP have been identified. Each type shows a relatively uniform clinical and pathological picture.
|
A365. familial Creutzfeldt-Jakob disease
|
|
Q366. prion disease?; pathological picture is characterized by; spongiform degeneration, excessive gliosis and sometimes deposition of ß-pleated amyloid plaques which are made up of insoluble protease-resistant accumulation of the altered PrPSC.
|
A366. Creutzfeldt-Jakob disease
|
|
Q367. TYPES OF SPORADIC CJD?; clinical sign: Dementia, ataxia; EEG: Sharp waves; Pathology: Occipital-parietal cortex
|
A367. M/M type 1
|
|
Q368. TYPES OF SPORADIC CJD?; clinical sign: Dementia; EEG: Diffuse slowing; Pathology: Cerebral cortex
|
A368. M/M type 2
|
|
Q369. TYPES OF SPORADIC CJD?; clinical sign: Ataxia, Dementia; EEG: Diffuse slowing; Pathology: Cerebellum (Kuru plaques)
|
A369. M/V type 2
|
|
Q370. TYPES OF SPORADIC CJD?; clinical sign: Dysarthria,; dysphagia, dementia; EEG: Periodic sharp waves; Pathology: Subcortical Involvement (thalamus)
|
A370. V/V type 2
|
|
Q371. what effect does Pathological PrPSC have on Schematic flow of pathogenetic mechanisms in prion disorders?
|
A371. Β-sheet conformation/ plaques; Protease resistant disease; also, Variations due to polymorphism and glycation of PrPSC give rise to specific disease entities.
|
|
Q372. inability to produce and/or comprehend language b/c brain damage
|
A372. Aphasia
|
|
Q373. inability to name, .e., “word finding” difficulty
|
A373. Anomia
|
|
Q374. acquired impairment in reading
|
A374. Alexia
|
|
Q375. impairment in writing
|
A375. Agraphia
|
|
Q376. inability to do arithmetic
|
A376. Acalculia
|
|
Q377. impairment in the execution of a motor act in the absence of weakness, sensory loss, or incoordination
|
A377. Apraxia
|
|
Q378. type of aphasia?; speech: poor; comprehension: intact; repetition: poor
|
A378. broca's aphasia
|
|
Q379. type of aphasia?; speech: fluent; comprehension: poor; repetition: poor
|
A379. wernicke's aphasia
|
|
Q380. type of aphasia?; speech: intact; comprehension: intact; repetition: poor
|
A380. conducion aphasia
|
|
Q381. type of aphasia?; speech: Poor; comprehension: poor; repetition: poor
|
A381. global aphasia
|
|
Q382. Dominant parietal lobe lesion (angular; gyrus = area 39); Finger agnosia; Left-right disorientation; Acalculia; Alexia with Agraphia; Usually not all 4 are present
|
A382. Gerstmann's syndrome
|
|
Q383. Deficits due to inability to transmit information from one area of cortex to another; After a complete callosotomy the right hand does not know what the left is doing, or what is in the left visual field
|
A383. Disconnection syndromes
|
|
Q384. type of amnesia?; Inability to form new memories; Korsakoff's syndrome
|
A384. Anterograde
|
|
Q385. type of amnesia?; Loss of premorbid memories; Ribot's law: more recent memories are most affected
|
A385. Retrograde
|
|
Q386. Bilateral limbic system lesions; Medial temporal lobes; Medial thalamic nuclei; Usually a mixture of anterograde and retrograde amnesia; Common after traumatic brain injury
|
A386. Amnestic Syndrome
|
|
Q387. type of amnesia?; Acute onset profound transient anterograde amnesia; Benign usually (migraine, seizure, TIA); Leaves a permanent memory gap; Full recovery of anterograde memory
|
A387. Transient Global Amnesia
|
|
Q388. type of amnesia?; Loss of personal identity and past; Intact memory for recent events; Occurs most often in fiction
|
A388. Psychogenic Amnesia; (psychogenic fugue)
|
|
Q389. Loss of multiple cognitive abilities in a person with a clear sensorium (no delerium)
|
A389. Dementia
|
|
Q390. DSMIV-R requires memory impairment plus impairment in one of:; language; judgement; abstract thinking; praxis; constructional abilities; visual recognition
|
A390. Dementia
|
|
Q391. Memory complaint, preferably corroborated by an informant; Objective memory impairment; Normal general cognitive function; Intact activities of daily living; Not demented
|
A391. Mild Cognitive Impairment Criteria
|
|
Q392. lesion: Left occipital and splenium of CC; associated deficits: Right hemianopia, color anomia or achromatopsia
|
A392. Alexia without Agraphia
|
|
Q393. lesion: Left hemisphere, angular gyrus; associated deficits: Right hemisensory, hemiparesis, and aphasia
|
A393. Alexia with Agraphia
|
|
Q394. Blind but preserved PLR
|
A394. Cortical Blindness
|
|
Q395. cortical blindness with anosognosia
|
A395. Anton’s Syndrome
|
|
Q396. type of syndrome?; Oculomotor apraxia—saccades; Optic ataxia—visually guided limb movements,; Simultanagnosia—foreground/background; Sometimes prosopagnosia—face recognition
|
A396. Balint’s syndrome
|
|
Q397. drug class used to tx AD?
|
A397. cholinesterase inhibitors should be considered for mild to moderate AD; donepezil (aracept); rivastigmine (exelon); galantamine (renimyl)
|
|
Q398. What disease do the following relate to?; Memory loss that affects job skills; Difficulty performing familiar tasks; Problems with language; Disorientation to time and place; Poor or decreased judgment; Problems with abstract thinking; Misplacing things; Changes in mood or behavior; Changes in personality; Loss of initiative
|
A398. Ten Warning Signs of AD
|
|
Q399. What disease requires the following evaluation?; Complete blood cell count; Serum electrolytes; Glucose; BUN/creatinine; Serum B12 levels; Liver function tests; Thyroid function tests; Depression screening
|
A399. Routine Evaluation of the; Demented Patient
|
|
Q400. drug?; indicated for the treatment of moderate to severe dementia of the Alzheimer's type (FDA); a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist
|
A400. Memantine (Namenda)
|
|
Q401. T or F?; Estrogen should be prescribed to treat AD
|
A401. False
|
|
Q402. type of headache?; Recurring headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of headache are unilateral location, pulsating quality, moderate or; severe intensity, aggravation by routine physical activity, and association with nausea, photo- and phonophobia
|
A402. Migraine without aura
|
|
Q403. type of headache?; Headache has at least two of :; Unilateral location; Pulsating quality; Moderate or severe intensity; Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs); During headache at least one of :; Nausea and/or vomitng; Photophobia and phonophobia
|
A403. Migraine without aura
|
|
Q404. type of headache:; least one of the following, but no motor weakness:; 1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/or negative features (ie, loss of vision); 2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness); 3. fully reversible dysphasic speech disturbance; At least two of the following:; 1. homonymous visual symptoms and/or unilateral sensory symptoms; 2. at least one aura symptom develops gradually over ≥5 minutes; and/or different aura symptoms occur in succession over ≥5 minutes; 3. each symptom lasts ≥5 and ≤60 minutes; Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes
|
A404. Typical aura with migraine headache
|
|
Q405. Warning signs in headache
|
A405. First & worst headache comes to the ER: needs a CT & LP to rule out subarachnoid hemorrhage (SAH); Headaches that awaken a patient at night or occur first thing in the morning suggest increased ICP; Palpable tender temporal arteries suggest GCA: check ESR; Cherry-red headache patients in winter: think CO; Virtually all headaches can cause nausea & vomiting
|
|
Q406. Headaches that awaken a patient at night or occur first thing in the morning is suggestive of what?
|
A406. suggest increased ICP
|
|
Q407. Palpable tender temporal arteries suggest GCA, check for what?
|
A407. ESR
|
|
Q408. clinical characteristic of virtually all headaches?
|
A408. Virtually all headaches can cause nausea & vomiting
|
|
Q409. Cherry-red headache patients in winter
|
A409. think CO
|
|
Q410. type of headache?; Excrutiating, penetrating, non-throbbing pain unilaterally, usually in the trigeminal distribution; Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, & ptosis; Peaks in 10-15 minutes, lasts 45-60 minutes; Occurs 1-3 times per day during cluster, often nocturnal; Typical cluster lasts 2-3 months and occurs every year or two; Affect men more often than women, 4-7:1
|
A410. Cluster Headache
|
|
Q411. type of headache?; Diffuse, bilateral, pressing or “tightening” quality, “like a band around the head”; Mild to moderate in severity; Usually episodic, may become chronic; Phonophobia, photophobia, or mild nausea occur rarely; Not really due to muscle tightness; Prevalence is 69% for men, 88% for women
|
A411. Tension-type Headache
|
|
Q412. Migraine is a _______ disorder
|
A412. neurovascular
|
|
Q413. what system is activated when Local vasodilatation of intracranial extracerebral blood vessels occurs; causes the release of vasoactive sensory neuropeptides, especially CGRP, that increase the pain response
|
A413. 'trigeminovascular system'; The activated trigeminal nerves convey nociceptive information to central neurons in the brain stem trigeminal sensory nuclei
|
|
Q414. drugs to tx migrane?; cause vasoconstriction through 5-HT1B receptors that are expressed in human intracranial arteries; inhibit nociceptive transmission through an action at 5- HT1D receptors on peripheral trigeminal sensory nerve terminals in the meninges and central terminals in brain stem sensory nuclei
|
A414. The 'triptan' anti-migraine agents (e.g. sumatriptan, rizatriptan, zolmitriptan, naratriptan) are serotonergic agonists
|
|
Q415. What should be avoided to abort a migraine except in the ER?
|
A415. Avoid narcotics except in ER
|
|
Q416. what is the specific tx for cluster headaches?
|
A416. 100% oxygen, ipsilateral intranasal 4% lidocaine for cluster headache
|
|
Q417. prophylaxis for migraine therapy
|
A417. Dietary: find precipitants; Caffeine, chocolate, nuts, aged cheeses, processed meats, alcohol (especially red wine); Beta blockers (especially propranolol); Daily naproxen; Calcium channel blockers; Amitriptyline and other tricyclics; Valproic acid (Depakote); Prednisone (short course) to break status migrainosus or cluster; Lithium for cluster headaches
|
|
Q418. type of headache?; Signs and symptoms of increased intracranial pressure without hydrocephalus; Usually small, slit-like ventricles; Mean age at onset 30 years, F:M 9:1; 90% of patients are obese, also associated with endocrinopathies, pregnancy, oral contraceptives, steroids, lithium, tetracycline, vitamin A intoxication
|
A418. Pseudotumor cerebri
|
|
Q419. What type of headache presents 100% of the time with papilledema?
|
A419. Pseudotumor cerebri
|
|
Q420. What type of headache requires the following treatment?; Weight loss; Acetazolamide; If there is progressive visual loss:; Optic nerve sheath fenestration; Lumbar-peritoneal shunting
|
A420. Pseudotumor cerebri
|
|
Q421. type of headache?; Paroxysmal, severe lancinating unilateral pain in the distribution of one or more branches of the trigeminal nerve; Episodes last <30-60 seconds evoked by stimulation of trigger points by touch, chewing or talking; Age is >40 years in 90%, F:M 3:2; Examination is normal
|
A421. Trigeminal Neuralgia or Tic Doloreux
|
|
Q422. what drugs are effective in 70-80% of cases in treating trigeminal neuralgia?
|
A422. Carbemazepine and phenytoin
|
|
Q423. what headache type can be treated in one of the following ways?; Carbemazepine and phenytoin each are effective in 70-80% of cases; • Tricyclics, baclofen, clonazepam, valproic acid, gabapentin can also be effective; Surgical treatments include microvascular decompression, percutaneous radiofrequency ablation of the trigeminal ganglion, local neurolysis and trigeminal rhizotomy
|
A423. Trigeminal Neuralgia
|
|
Q424. type of headache?; Patients are usually >60 years old Symptoms:; headache, often in temporal or occipital areas; fever, malaise, weight loss; jaw claudication; sudden vision loss Signs and findings; tenderness over the temporal arteries; elevated ESR; vasculitis on biopsy Treatment: oral prednisone
|
A424. Giant Cell or Temporal Arteritis
|
|
Q425. location of diffuse astrocytoma in adults?
|
A425. AGE/LOCATION:; adults: most common in cerebral hemispheres
|
|
Q426. location of diffuse astrocytoma in children?
|
A426. children: most common in brainstem, diencephalon (thalamus, hypothalamus)
|
|
Q427. sx of a lacunar thalamic stroke
|
A427. sensory
|
|
Q428. sx of a lacunar pontine stroke
|
A428. dysarthria, clumsy hands
|
|
Q429. most common locations for a berry aneurysm in brain
|
A429. pca > aca > mca
|
|
Q430. medical tx for SAH
|
A430. CCB to prevent vasospasms; gradually decrease BP
|
|
Q431. complications of SAH
|
A431. 30% re-rupture; 50% vasospasm
|
|
Q432. which way do eyes deviate in a stroke involving the pons
|
A432. away
|
|
Q433. which way do eyes deviate in a stroke involving the cortex
|
A433. towards
|
|
Q434. which way do eyes deviate in a stroke involving the thalamus
|
A434. eyes deviate downwards
|
|
Q435. most common cause of ICP
|
A435. sudden increase in BP
|
|
Q436. most common cause of SAH
|
A436. ruptured aneurysm
|
|
Q437. most common cause of ischemic stroke
|
A437. embolic stroke
|
|
Q438. most common cause of lacunar stroke
|
A438. microathetroma and lipohylinosis; in small penetrating arteries of brain
|
|
Q439. where is the lesion:; paralysis of left side of tongue with right limb weakness
|
A439. paramedian medulla oblongata
|
|
Q440. where is the lesion:; left facial pain, vertigo and vomiting at onset with loss of pain and temp in L face; loss of pain and temp in R limbs adn trunk; L horner's syndrome; dysphagia
|
A440. wallenberg syndrome; (2/2 PICA or vertebral artery branch infarct)
|
|
Q441. where is the lesion:; left 3rd nerve palsy and right hemiplegia; (if awake); if unconscious
|
A441. midbrain involving basis pedunculi and cn III; left cerebral mass lesion with increased icp
|
|
Q442. where is the lesion:; left 3rd nerve palsy with involuntary movements and incoordination of right limbs
|
A442. midbrain involving red nucleus and cn iii
|
|
Q443. cogwheel rigidity; tremor at rest; postural instability; Lewy bodies; depigmentation of Snc
|
A443. PARKINSON'S; possible link to MPTP
|
|
Q444. contralateral subthalamic nucleus damage
|
A444. hemiballismus
|
|
Q445. Huntington cerebral appearance
|
A445. caudate atrophy; enlarged ventricles; (loss of GABAergic neurons)
|
|
Q446. depression; chorea; progressive dementia; chromosome 4 defect
|
A446. Huntington
|
|
Q447. Friedrich's ataxia; inheritance; defect; sx
|
A447. auto Recessive; GAA repeat; ataxia; hypertrophic cardiomyopathy; spasticity; loss of joint sensation; decreased joint sensation; posterior spinal cord; spasticity; lateral spinal cord
|
|
Q448. Werdnig-Hoffman; inheritance; defect; sx
|
A448. auto recessive; anterior horn LMN degeneration; floppy baby; spinal muscular atrophy; tongue fasiculations; death median 7 mts
|
|
Q449. severe abdominal pain; psychosis; peripheral neuropathy; dementia
|
A449. Acute intermittent prophyra; autoD; (-)uroporphyrogen snythase; PBG, delta-ALA accumulation; wine urine on oxidation
|
|
Q450. Acute intermittent porphyra; inheritance; defect; accumulation; sx
|
A450. autoD; (-)uroporphyrogen synthase; PBG, delta-ALA accumulation; wine urine on oxidation; severe abdominal pain; psychosis; peripheral neuropathy; dementia
|
|
Q451. Broca lesion
|
A451. expressive aphasia; difficulty speaking; understanding intact
|
|
Q452. fluent speech; difficulty understanding; poor repetition
|
A452. Wernicke's receptive aphasia; neologisms
|
|
Q453. fluent speech; good understanding; poor repetition
|
A453. Arcuate conduction aphasia
|
|
Q454. poor speech; good understanding; poor repetition
|
A454. Broca's expressive aphasia
|
|
Q455. fluent speech; difficulty understanding; repetition intact
|
A455. transcortical sensory
|
|
Q456. poor speech; difficulty understanding; repetition intact
|
A456. transcortical mixed; can only repeat
|
|
Q457. poor speech; difficulty understanding; poor repetition
|
A457. global; profound; nonverbal
|
|
Q458. bilateral amygdala lesion
|
A458. amygdala-la land of sex; Kluver-Bucy syndrome; disinhibition; hyperorality; hypersexuality
|
|
Q459. Frontal lobe lesion
|
A459. disinhibition; mood changes; difficulty concentrating
|
|
Q460. parietal lobe lesion
|
A460. contralateral hemineglect
|
|
Q461. Midbrain reticular activating system
|
A461. reduced arousal, activity
|
|
Q462. bilateral mammary bodies
|
A462. Wernicke-Korsakoff; ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia
|
|
Q463. ataxia, confusion, confabulation; ophthlamoplegia; psychosis; anterograde amnesia
|
A463. Wernicke's-Korsakoff
|
|
Q464. truncal ataxia; poor motor speech/dysarthria
|
A464. cerebellar vermis
|
|
Q465. contralateral hemiballismus
|
A465. subthalamic nucleus; basal ganglia
|
|
Q466. anterograde amnesia
|
A466. hippocampus
|
|
Q467. paramedian pontine reticular formation (PPRF); location; unilateral lesion
|
A467. pons; eyes look AWAY from side of lesion; contralateral gaze deviation; uPP(RF) and AWAY
|
|
Q468. Frontal eye fields lesion
|
A468. inability to initiate voluntary mvmt; eyes look TOWARDS lesion; sit TOWARDS the FRONTal
|
|
Q469. Broca's area location
|
A469. inferior frontal gyrus
|
|
Q470. Wernicke's location
|
A470. superior temporal gyrus
|
|
Q471. contralateral loss of pain, temp; visual field loss w/ macular sparing; ispilateral oculomotor nerve palsy hemiparesis,hemiplegia. Horner's
|
A471. PCA; midbrain; optic tracts; thalamus
|
|
Q472. foot and leg paralysis; foot and leg sensory loss; gait disturbance; transcortical motor aphasia; (left stroke)
|
A472. contralateral ACA; (stroke prior to the anterior communicating artery okay b/c collateral circulation)
|
|
Q473. face-trunk-arm paralysis; face-trunk-arm loss of sensation; Broca's/Wernicke's aphasia; hemineglect (parietal lobe); vision loss
|
A473. contralateral MCA
|
|
Q474. oculomotor palsy
|
A474. posterior communicating artery; PCA
|
|
Q475. bitemporal hemianopsia
|
A475. Acomm a. aneurysm; Pituitary adenomas; Craniopharyngiomas.
|
|
Q476. pure motor hemiparesis following stroke; artery; patholocation
|
A476. lateral striate/ MCA; lacunar infarct of internal capsule
|
|
Q477. severe vertigo; nystagmus; ipsilateral ataxia; difficulty swallowing; Horner's
|
A477. PICA
|
|
Q478. paralysis of all extremities; profound loss of sensation; respiratory difficulty
|
A478. basilar artery infarct; "locked in syndrome"
|
|
Q479. nuchal rigidity; worst headache of life; bloody, xanthrochromic tap
|
A479. subarachnoid hemorrhage; berry aneurysm rupture; AVM
|
|
Q480. cresentic hematoma; crosses sutures; delayed onset of symptoms; flux of consciousness; bridging veins; elderly, alcohol, shaken baby; whiplash
|
A480. subdural hematoma
|
|
Q481. hematoma crosses falx, tentorum
|
A481. epidural
|
|
Q482. hematoma crosses suture
|
A482. subdural
|
|
Q483. () biconvex hematoma; lucid interval; middle meningeal artery; temporal bone fracture
|
A483. epidural hematoma; middle meningeal artery
|
|
Q484. hydrocephalus; paralysis of upward gaze; dilated lateral, munro, 3rd ventricle
|
A484. congenital stricture of aqueduct of sylvius
|
|
Q485. dilated lateral, munro, 3rd ventricle, sylvian aqueduct, 4th ventricle
|
A485. Dandy Walker; foramen of Luschka, Magendie stenosis
|
|
Q486. spinal tap structures are pierced ...
|
A486. SLED SAS; skin/superficial fascia; ligaments:; supraspinatus; interspinatous; flavus; epidural space; dura mater; subdural space; arachnoid; subarachnoid space
|
|
Q487. LMN destruction in anterior horn
|
A487. Polio; Werdnig-Hoffmann
|
|
Q488. asymmetric diffuse spinal and cortical lesions in white matter
|
A488. MS
|
|
Q489. lesions in ventral column; anterior horn; corticospinal
|
A489. ALS; axial motor defects (ant horn); UMN/LMN motor defects (corticospinal)
|
|
Q490. anterior spinal artery occulsion
|
A490. spares dorsal column; anterior horn; corticospinal tract; spinothalamic tract
|
|
Q491. posterior spinal artery occlusion
|
A491. dorsal column
|
|
Q492. degeneration of dorsal roots, columns; disease; sx
|
A492. tabes dorsalis; locomotor ataxia, (proprioception); impaired touch
|
|
Q493. degeneration of region between anterior horn; disease; sx
|
A493. syringomyelia; bilateral loss of pain and temperature sensation; damages crossing fibers of spinothalamic tract
|
|
Q494. dorsal column; lateral corticospinal; spinocerebellar tracts; demylenation; disease; sx
|
A494. B12 defiency; Fridrick's ataxia; hyperreflexia; neuropathy; ataxia; impaired position sense
|
|
Q495. anterior horn destruction; fasciculations, fibrillation; muscle weakness, atrophy; CSF lymphocytic pleocytosis
|
A495. poliomyelitis; virus replicates in oropharyx, intestines; cx from stool, throat
|
|
Q496. anterior horn destruction; floppy baby; tongue fasiculations; death at 7 mths
|
A496. Werdnig-Hoffman
|
|
Q497. superoxide dismutase defect; hand atrophy; spasticity; weakness; +babinski
|
A497. ALS
|
|
Q498. rapid sensory motor loss; immunocompromised state; oligocyte inclusions; disease, agent
|
A498. progressive multifocal leukoenephalopathy; JC virus
|
|
Q499. parkinsonism; putamen/basal ganglia; atrophy, cavitary necrosis; hyperpigmentation; liver cirrhosis
|
A499. Wilson's disease
|
|
Q500. history of measles; personality change, seizures, myoclonus, ataxia, photosensitivity,; progressive psychomotor decline/death; oligodendrocyte inclusions
|
A500. subacute sclerosising panencephalitis; chronic measles infection
|
|
Q501. loss of joint sensation; shooting pain; history of sexual activity; loss of DTR; locomotor ataxia
|
A501. tabes dorsalis
|
|
Q502. staggering gait; nystagmus; hypertrophic cardiomyopathy; childhood kphoscoliosis; familial frataxin gene repetition
|
A502. Friedrich's ataxia
|
|
Q503. trauma, TB, MS; Hemiparaplesia; ispi UMN symptoms; ipsi loss of touch, vibration below; loss of all motor/sensation at lesion; contralateral loss of pain, T; +/- Horner's symptoms (above T1)
|
A503. hemisection of spinal cord; Brown-Sequard
|
|
Q504. HIV; periventricular calcifications; intranucelar basophlic inclusions
|
A504. CMV meningitis
|
|
Q505. Horner's syndrome; sx; lesion
|
A505. ptosis; miosis; anhydrosis; spinal cord lesion above T1
|
|
Q506. history of MS; normal convergence; nystagmus on abduction of eye; medial rectus palsy on lateral gaze
|
A506. MLF syndrome; medial longitudinal fasculus lesion
|
|
Q507. sudden loss of vision; MLF; hemiparesis/sensory sx; bladder/bowel incontinence; scanning speech; intention tremor; nystagmus
|
A507. MS
|
|
Q508. MS associated with what HLA class
|
A508. DR2; 2 Drs can't cure MS
|
|
Q509. postviral; acute perivenular inflammation; demyleination
|
A509. acute disseminated encephalomyelitis
|
|
Q510. Metachromatic leukodystophy; inheritance; deficiency; accumulated substance; disease
|
A510. autorecessive; arylsulfatase A deficiency; sulfatides buildup; impaired myelin sheath
|
|
Q511. CNS symptoms with; adrenal insufficiency; familial
|
A511. Adrenoleukodystrophy; autorecessive; LCFA buildup destroys myelin
|
|
Q512. unilateral periorbital pain; brief repetitive headaches; ipsilateral lacrimation; rhinorrhea; Horner's
|
A512. cluster headache
|
|
Q513. medullary cerebral vermis herniation through foramen magnum; dilation of lateral, 3rd, sylvian duct; flatten base of skull; meningomyocele, syringomelia
|
A513. Arnold Chiari
|
|
Q514. vermis hypoplasia; cystic dilation of lateral, 3rd,sylvian, 4th ventricles,; hydrocephalus; obstructed foramen Luska/Magn
|
A514. Dandy Walker
|
|
Q515. loss of pain, T in hands; atrophy of intrinsic hand muscles; fluid filled cervical cord enlargement; anterior horn destruction; +/- Chiari herniation
|
A515. syringomyelia
|
|
Q516. port wine stains; leptominingeal angioma, AVM; glaucoma; seizure; hemiparesis; MR
|
A516. Sturge-Weber
|
|
Q517. cafe au lait; pigmented iris harmartomas; neurofibromas; auto d
|
A517. neurofibromatosis 1
|
|
Q518. cavernous hemangiomas; RCC; hemangioblastoma in retina
|
A518. VHL
|
|
Q519. corticocerebellar atrophy; central pontine myelosis
|
A519. alcholism
|
|
Q520. mouth drop; difficulty speaking; inability to close eye; unilateral facial paralysis
|
A520. Bell's palsy
|
|
Q521. Bell's palsy; unilateral causes; bilateral causes
|
A521. HIV, Sarcoidosis; bilateral = LYME
|
|
Q522. + GFAP; pseudopalisading tumor; central necrosis, hemorrhage; can cross corpus callosum
|
A522. GBM astrocytoma
|
|
Q523. spindle cells; arachnoid cell origin; can invade bone; psammoma bodies
|
A523. meningioma
|
|
Q524. chicken wire capillaries; frontal lobe calcification; fried egg cells
|
A524. olgiodendroglioma
|
|
Q525. Positive GFAP; posterior fossa; eosinophilic corkscrew rosenthal fibers; cystic
|
A525. pilocystic astrocytoma
|
|
Q526. neuroectodermal; can compress 4th ventricle; hydrocephalus; rosettes, perivascular pseudorossets
|
A526. medulloblastoma
|
|
Q527. perivascular pseduorosettes; rod shaped basal ciliary bodies near nucelus; hydrocephalus if in 4th ventricle
|
A527. ependymoma
|
|
Q528. vascular tissue; foamy cells; polycythemia; associated with VHL; cerebellar
|
A528. hemangioblastoma
|
|
Q529. dilated pupils; eye down adducted; ptosis; herniation of medial temporal lobe; occipital infarct
|
A529. uncal herniation
|
|
Q530. tonic clonic first line
|
A530. phenytoin; carmnbamazepime; depakote
|
|
Q531. absence first line
|
A531. ethosuximide; (depakote ok)
|
|
Q532. phenytoin; MOA; toxicity
|
A532. Na channel inactivation; nystagmus, gingival hyperplasia; decreases warfarin
|
|
Q533. BDZ; MOA; toxicity
|
A533. increase GABA conc; sedation, dependence
|
|
Q534. Carbamazepine; MOA; toxicity
|
A534. Na channel inactivation; teratogenic, agranulocytosis, aplasic anemia, diplopia, hepatotoxicity
|
|
Q535. Phenobarbital; MOA; toxicity
|
A535. increases GABA a activity; dependence; decreases warfarin
|
|
Q536. Valproic acid; MOA; toxicity
|
A536. Na channel inactivation, increases GABA; teratogenic; weight gain; fatal hepatotoxcicity; spina bifida; inhibits phenobarital metabolism
|
|
Q537. Lamotrigine; MOA; toxicity
|
A537. blocks Na channels; Steven Johnsons
|
|
Q538. Gabapentin; MOA
|
A538. GABA analog
|
|
Q539. Topiramate
|
A539. blocks Na channels; renal stones; mental dullness; weight loss
|
|
Q540. Ethosuximide
|
A540. blocks thalamic T-Ca channels
|
|
Q541. Dantrolene MOA
|
A541. prevents release of Ca from SR of skeletal muscle
|
|
Q542. Bromocriptine; MOA
|
A542. dopamine receptor agonist
|
|
Q543. Amantadine; MOA
|
A543. increases dopamine release
|
|
Q544. Ldopa/carbidopa; MOA
|
A544. increases dopamine concentration in synapse
|
|
Q545. Selegline; MOA
|
A545. selective MAO B inhibitor; prevents dopamine degradation
|
|
Q546. Benztropine
|
A546. antimuscarinic (like atropine); improves parkinsonian tremor
|
|
Q547. Ldopa overdose give _________
|
A547. clozaprine
|
|
Q548. Memantine
|
A548. NMDA receptor antagonist; prevents excitotoxicity in Alzhemier's
|
|
Q549. Donepezil
|
A549. Ach inhibitor for parkinsons
|
|
Q550. dilated pupil; +tachy, hypertension; tremor, seizure; overdose on _________?
|
A550. cocaine; amphetamine; caffiene; pseudoephedrine
|
|
Q551. dilated pupil; hypervigilence; agitation; hallucination; delirum, coma
|
A551. antihistamine; TCA; atropine; scopolamine; Jimson weed; antiparkinsonins
|
|
Q552. dilated pupil; hyperthermia, tachy, htn; agitation, nystagmus
|
A552. PCP (vertical nystagmus); LSD; mescaline; MDMA
|
|
Q553. seizure; chorea; arrhythmia; tachycardia; hyper-->hypotension
|
A553. TCA overdose
|
|
Q554. hypothermia; bradycardia; CNS depression; hyporeflexia; pulm edema
|
A554. heroin; oxycodone; morphine; meperidine
|
|
Q555. confusion; coma; salivation; incontenence; diaphroesis; bronchoconstriction; fasciulation
|
A555. organophosphates; pilocarpine; phyostigme; edrophonium; bethanecol
|