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Neuro review 1

A 41-year-old female presents to the ED with complaint of sudden onset of "worst headache of my life." A stat CT scan of her head is normal. Next appropriate step to diagnose the patient is: Lumbar puncture*
most common abdominal cancer in children neuroblastoma
To look for brain tumor in a CT, use Contrast
Cranial nerve associated with the Sense of smell I Olfactory*
Cranial nerve that transmits visual information to brain II Optic*
Cranial nerve that innervates superior oblique muscle, which depresses, rotates laterally, and medially rotates the eyeball. IV Trochlear*
Cranial nerve associated with sensation from face and innervates muscles of mastication. V1- ophthalmic. V2- maxillary. V3- mandibular. V Trigeminal
Cranial nerve which innervates lateral rectus (abducts eye) VI Abducens*
Cranial nerve with motor to muscles of facial expression, special sense of taste from anterior 2/3 of tongue, and secretomotor to salivary glands (except parotid) and lacrimal gland VII Facial
Cranial nerve associated with senses sound, rotation and gravity (balance and movement) VIII Vestibulocochlear
Cranial nerve associated with taste from posterior 1/3 of tongue. Secretomotor to parotid gland. Motor to stylopharyngeus. IX Glossopharyngeal*
Cranial nerve associated with motor to muscles of tongue and other glossal muscles. important for swallowing (bolus formation) and speck articulation Hypoglossal*
Cranial nerve that controls sternocleidomastoid and trapezius. Overlaps fxn with vagus. Damage: inability to shrug, weak head movement Accessory
Glasgow comma scale assesses Eye opening, verbal response, and motor response*
Untreated phenylketonuria results in Mental retardation*
Increased muscle tone is called Spasticity
Decreased muscle tone is called Flaccidity
Rigidity that persists throughout the range of motion is called Lead pipe rigidity
MCC of bacterial meningitis in a child less than 4 weeks Group B strep*
MCC of bacterial meningitis in a child 4 to 6 weeks H. flu, N. meningitides*
MCC of bacterial meningitis in a child over 6 weeks S. pneumonia, N. meningitides*
Gold standard for diagnosis of meningitis Lumber puncture*
Degenerative organic mental disease characterized by progressive intellectual deterioration and dementia Alzheimer's disease
Paralysis or weakness of the muscle of the face supplied by the facial nerve Bell's palsy
Demyelization disease of the peripheral nerves causing acute progressive weakness (an ascending paralysis) Guillain-Barre syndrome
An autoimmune disorder of neuromuscular transmissions involving the production of auto-antibodies directed against the nicotinic acetylcholine receptors Myasthenia gravis
First line therapy for myasthenia gravis is Cholinesterase inhibitors
Treat acute cluster headache with Oxygen and sumatriptan (Imitrex)*
Peak incidence of viral meningitis is in Summertime*
Sensorium in encephalitis is Impaired
Sensorium in meningitis is normal
Most common cause of viral meningitis Enteroviruses*
Inflammation in response to bacterial infection of the pia-arachnoid & fluid of the ventricles Bacterial meningitis
Etiology of bacterial meningitis in in adults Strep. pneumoniae
Treatment for bacterial meningitis in ages 3 months to 50 year old Ceftriaxone & Vancomycin*
Involuntary repetitive contraction of agonist & antagonist muscles producing rhythmic oscillation about a joint at a regular frequency Tremor
Treat Parkinson's disease with Entacapone, carbidopa, levodopa*
Inherited disease characterized by dementia & chorea Huntington's disease*
Huntington's disease is a genetic Autosomal dominant
To treat choreoathetosis in Huntington's use Clonazepam (klonopin)*
To treat dyskinesia and/or behavioral problems in Huntington's use Haloperidol (Haldol)
To treat rigidity in Huntington's use Baclofen (lioresal)
To treat depression in Huntington's use Fluoxetine (Prozac)
Ataxia, Babinski sign, & optic neuritis are seen in Multiple sclerosis*
Treat spasticity in multiple sclerosis with Baclofen (lioresal)
Treat neuropathic pain in multiple sclerosis with Gabapentin (Neurontin)
Treat multiple sclerosis with Methylprednisolone*
Treat chronic fatigue in multiple sclerosis with Amantadine
Treat relapsing multiple sclerosis with Methotrexate & Azathioprine (Imuran)
Seizure manifested by focal motor symptoms (convulsive jerking), spread to different parts of the body Simple partial seizure*
Seizure with impaired consciousness and automatisms (lip smacking, chewing) Complex partial seizure*
Paroxysmal loss of consciousness & brief discontinuation of activity followed by abrupt recovery, with no recollection of the event Absent seizure
Brief stare and change in facial expression, < 20 sec Absence (petit mal) seizure*
Epileptic seizure longer than 30 minutes or absence of full recovery of consciousness between seizures Status epilepticus
To treat an acute seizure use Lorazepam (Ativan)*
If seizure persists for more than 5 minutes and Ativan has been given, give Fosphenytoin (cerebyx)
In cerebral vascular disease, an LP will show Xanthochromia (yellowish color)
Abrupt onset of headache associated with stiff neck & photophobia Subarachnoid hemorrhage*
Subarachnoid hemorrhage is bleeding into the Subarachnoid space
"worst headache of my life" Subarachnoid hemorrhage*
The sudden onset of a focal and transient (< 24 hrs) neurological deficit due to brain ischemia Transient ischemic attack (TIA)
Vise like headache Tension headache*
Boring, peri-orbital headache Cluster headache*
Shape of subdural hematoma Crescent shape*
Shape of epidural hematoma Lenticular hematoma
Type of bleed in subdural & epidural hematomas Subdural - venous; epidural - arterial
Nuchal signs in meningitis are Kernig's and brudzinski's signs*
Chronic deterioration of mental function sufficiently severe to interfere with daily living Dementia
HA with aura symptoms Migraine
Classic signs of Migraines Pulsatile, throbbing
Migraine H/A are associated with what hormone imbalance? Estrogen
treat vertigo with meclizine
Headache behind the eyes, painful, lasting 2 hours at night. cluster
A writing cramp Focal dystonic
VIII. Vestibulocochlear Nerves Hearing and balance
XI. Accessory Nerves Control neck, larynx, and shoulder muscles
XII. Hypoglossal Nerves Control tongue movements
Most common intracerebral neoplasm is a Glioma*
Scoliosis treatment at 20 -40 degrees Brace
Wernicke's area is located in the posterior of the Superior Temporal gyrus
Most common solid brain tumor in kids Astrocytoma*
Scoliosis is more common in Females*
extensor hallucis longus (EHL) strength L5
LR6 SO4 all others 3 stands for LR6--Lateral rectus (VI abductens) SO4--Superior Oblique ( IV Trochlear) 3--The remaining 4 eyeball movers = III
Thymine is given before glucose to prevent Wernicke Encephalopathy
winning of the scapula is due to Serratus anterior paralysis caused by damage to the long thoracic nerve
Define Tenosynovitis inflammation of a tendon sheath
Cranial nerve that is a hook that closes the eyes Facial (CN 7)*
Cranial nerve that are pillars that open the eyes Oculomotor (CN 3)*
If the forehead and eye are not affected in a palsy, think Stroke
Cranial nerve associated with the gag reflex Vagus (X)*
Dermatomes C6 Thumb
Dermatomes T4 Nipple
Dermatomes T10 Umbilicus
Dermatomes L5 Great toe
Dermatomes S5 Anal sphincter
Most common cause of subarachnoid hemorrhage trauma
Most common cause of atraumatic subarachnoid hemorrhage Ruptured brain aneurysm
Thunderclap headache or worst headache of my life Subarachnoid hemorrhage
Brain hemorrhage associated with a lucid interval Subdural hematoma
Bridging vessels tear during trauma in Subdural hematoma
Worst form of cerebal palsy Spastic quadriplegia
Using this medication class will make Guillain Barre syndrome worse Steroids
"The sheets hurt" on my legs Diabetic neuropathy
Ptosis, diplopia, cannot move eyes, weakness of skeletal muscle Myasthenia Gravis
Best test for myasthenia Gravis diagnosis Acetylcholine receptor anti-bodies*
Most common cause of chronic daily headache Overuse of OTC
Treat cluster headaches with High flow O2 and Imitrex shots*
Average age of onset for Multiple sclerosis 20 to 40*
Key presentation for multiple sclerosis New neurological symptom in a young person*
Most common type of multiple sclerosis Relapsing remitting*
"Dawson's fingers" on MRI is classic for Multiple sclerosis*
20 to 40 y/o female with eye issues and white spots Multiple sclerosis*
Seizure that involves pelvic thrusting is a Pseudoseizure
Whole body convulsions with no pelvic thrusting Tonic clonic seizure
All anti-epilepsy drugs meds contain a black box warning for Suicide risk
This seizure drug should be avoided in women of child bearing age depakote
Major disease of memory impairment in people over 85 yo Alzheimer's
Gold standard test to diagnosis Alzheimer's disease Brain biopsy
Drug class to treat Alzheimer's disease Acetylcholine esterase inhibitors
Memory impairment that is associated with medication Delirium
An action/ postural tremor of the hands (Benign) essential tremor
the hand shakes when you reach for something or a yes or no head bob (Benign) essential tremor
Tremor in Parkinson's is a Rest tremor
Dopamine depletion in the basal ganglia Parkinson's disease
Cogwheel rigidity Parkinson's disease
Most common symptom at presentation of Parkinson's disease Rest or pillrolling tremor
Tyramine restricted diets are required with which medication class MAOIs
Sign where resistance to flexing hip 90 degrees while knee is fully extended Kernig sign
Sign where flexion of the neck causes flexion of the hip Brudzinski sign
Worst form of Spina bifida Myelomeninocele
Test for the optic cranial nerve include Visual acuity with snellen chart & visual fields by confrontation
Test for the Oculomotor cranial nerve include Extra ocular movements & response to light and accommodation
cranial nerve that is a hook that closes the eyelid Facial nerve (CN 7)
Three sensory divisions of trigeminal nerve Ophthalmic, maxillary & mandibular
Motor functions of the trigeminal nerve Temporal & masseter muscle strength & lateral movement of jaw
Motor function of the facial cranial nerve Symmetry of facial muscles with raising eyebrows, smile, frown, purse lips, puffing cheeks, showing teeth & squeezing eyes shut
Sensory function of the facial cranial nerve Taste sensation to the anterior 2/3 of tongue
Function of glossopharyngeal cranial nerve Taste sensation to posterior 1/3 of tongue
Function of Vagus cranial nerve Sensory innervation of pharynx & larynx; gag reflex
Upper motor neuron lesions Increased tone & spasms, hyperreflexia, Babinski, clonus
Lower motor neuron lesions Flaccid tone, fasciculation's, reduced reflexes
Test for coordination (cerebellum) Rapid alternating movements, pass pointing & heel to shin testing
Tests for gait & station include Posture, ambulation, turning & postural stability
Types of ischemic strokes include Thrombus, embolism or systemic hypoperfusion
Types of hemorrhagic stroke include Intracerebral, subarachnoid & subdural
Posterior circulation to the brain includes Vertebral & basilar arteries
Signs & symptoms of anterior carotid circulation stroke Aphasia, amaurosis fugax, hemiparesis, hemisensory deficit
Amaurosis fugax is Transient monocular blindness
Signs & symptoms of vertebrobasilar stroke Bilateral visual loss, diplopia, ataxia, vertigo, syncope, dysarthria & vomiting
Non-modifiable vascular disease risk factors Age, male, African American, & family history of stroke
Modifiable vascular disease risk factors Smoking, HTN, hypercholesterolemia, diabetes, atrial fibrillation
A stroke that affects both sides of the brain or multiple vascular distributions Embolic stroke
MOA Plavix (clopidogrel) Irreversibly binds P2Y receptor causing impaired aggregation for the life of the platelet
Adverse effects of Plavix (clopidogrel) Rash, bleeding & rare reports of fatal TTP
Chronic stroke treatment Aggrenox, Coumadin or pradaxa
Aggrenox is Dipyridamole 200 mg/ aspirin 25 mg
MOA Aggrenox ASA permanently inhibits thromboxane A2 via cyclooxygenase; dipyridamole limits adenosine uptake into platelet
Side effects of Aggrenox HA, GI intolerance, bleeding
MOA of Dabigatran (Pradaxa) Direct thrombin inhibitor
Patients with an acute stroke ipsilateral to a carotid stenosis of 70 - 95% should undergo Endarterectomy (or stinting)
Patients with < 70% carotid stenosis, do Serial imaging
Intracranial hemorrhage risk factors Age, HTN, pregnancy, black, hemodialysis & amphetamine & cocaine use
Risk factors for brain aneurysm Smoking, HTN, family members
Major risk for subarachnoid hemorrhage Vasospasms & hydrocephalus
Tx of subarachnoid hemorrhage Swallow, seizure prophylaxis & Nimotop (Nimodipine (CCB))
Subdural hematoma will progress to Chronic hygroma
Convex lesion on imaging Epidural hematoma
Causes of cerebral palsy Prematurity, intrauterine growth restriction, antepartum bleed & placental pathology
Define cerebral palsy A group of non-progressive clinical syndromes characterized by motor and postural dysfunction
Spastic syndrome cerebral palsy Hypertonia, hyperreflexia, clonus, Babinski sign, difficulty initiating individual movements
Spastic diplegia cerebral palsy Affecting the legs
Spastic hemiplegia cerebral palsy Affects more arms then legs, cortical
Athetosis Slow smooth writing movements
chorea Rapid unpredictable movements
Dystonia Repetitive twisting of limbs & trunk
Dyskinetic syndromes seen in cerebral palsy Athetosis, chorea, dystonia
Tx of generalized spasms in cerebral palsy Tizanidine, benzodiazepine, lioresal, dantrium
Dorsal rhizotomy Selective cutting of the dorsal root of the nerve root, interruption of the reflex arc; done in cerebral palsy
Cerebral palsy is associated with Mental retardation, epilepsy & sensory impairment
Bell's Palsy Sudden onset of unilateral facial weakness with hyperacusis, taste changes & post auricular pain
Treatment of Bell's palsy Steroids started within 72 hrs
Classic finding of Guillain Barre is Elevated CSF protein with no white cells
MC infections agent to cause Guillain Barre campylobacter
Treatment of Guillain Barre includes IVIG or plasmapheresis
Presentation of diabetic neuropathy Pain, burning, numbness in legs, Allodynia
Allodynia is The sheets hurt
MC muscle to become weak with Myasthenia Gravis Ocular
Myasthenia Gravis Disorder of the neuromuscular junction in which antibodies bind acetylcholine receptors preventing muscle contraction
Presentation of Myasthenia Gravis Ptosis, diplopia, dysarthria, dysphagia, chewing, neck muscles, & limb muscle weakness
Treatment for Myasthenia Gravis IVIG or plasmapherisis, mestinon
MOA of Mestinon (pyridostigmine) Blocks breakdown of acetylcholine allowing more to stay in neuromuscular junction
Treatment of migraine headache Triptans, ergotomine, antiemetics
Prophylaxis drugs in migraine Propranolol, verapamil, lisinopril, & candesartan
Antidepressants for migraine headache Elavil (amitriptyline)
Biggest risk factor for temporal arteritis Age over 50
Confirm temporal arteritis with a Biopsy
Treatment for giant cell temporal arteritis Long term steroids
Associated features of multiple sclerosis Sphincter incontinence, depression, fatigue, sexual dysfunction, & cognitive decline
Treatment for multiple sclerosis Interferon Beta
Side effects of interferon Beta include Injection site reactions, flu like syndrome, depression, elevated LFTs & depression
Treatment for absence seizure Ethosuximide, depakote, lamictal & klonopin
Treatment for tonic clonic seizures Depakote, Topamax, Dilantin
Side effect of carbamazepine (Tegretol) Dizzy, somnolence, Has, Hyponatremia, increased LFTs & low WBCs
Treatment in Alzheimer's disease Aricept (Donepezil); Exelon (Rivastigmine); Razadyne (Galantamine) & Namenda (Memantine)
Treatment for essential tremor Propranolol, mysoline, Topamax
MOA cardiodopa Inhibit peripheral metabolism of levodopa into dopamine reducing side effects and allowing it to cross the blood brain barrier
Side effects of dopamine Motor fluctuations, dyskinesia, nausea, somnolence, dizziness, & hallucinations
Classic triad of meningitis Fever, nuchal rigidity & change in mental status
Strokes associated with A-fib are more likely to involve Large cerebral vessels
Risk factors for stroke after an MI Low ejection fraction, A-fib, advanced age, smoking, prior stroke
MCC of subarachnoid hemorrhage trauma
Triptans include Sumitripan, zolmitriptan, rizatriptan
MOA of triptans inhibit release of vasoactive peptides, promote vasoconstriction, & block pain pathways
selective agonist for serotonin receptors in cranial arteries triptans
Triptans are used for Migraine
triptans with SSRI & MAOI can lead to serotonin syndrome
ADRs of triptans AMI type symptoms
Cholinesterase inhibitors include donepezil, rivastigmine, galantamine, tacrine
Cholinesterase inhibitors are used for alzheimer's disease
MOA of Cholinesterase inhibitors increase cholinergic transmission by inhibiting cholinesterase at synaptic cleft
first line treatment for parkinson's disease is levodopa with carbidopa (+/-) entacapone
dopamine agonist include pramipexole, ropinirole
anticholinergics include trihexyphenidyl, benztropine
selective MOA B Inhibitors include selegiline, rasagiline
NMDA antagonist amantidine
MOA of levodopa circulates in plasma to BBB where it crosses & is decarboxylated to dopamine
Levodopa is metabolized in the periphery by what 2 enzymes dopa decarboxylase & Catechol-O-methyl-transferase (COMT)
ADRs of parkinson therapeutics include N/V, anorexia, orthostatic hypotension, vivid dreams, hallucinations, delusions, confusion, sleep disturbance
ADRs associated with Levodopa On-Off syndrome & wearning off phenomenon
Anti-Epileptic drugs include Phenytoin, Carbamazepine, Valproate, Gabapentin, Lamotrigine
Use of phenytoin prevention of seizures following head trauma /NS
ADRs of Phenytoin include Gingival Hypertrophy, fetal hydantoin syndrome, fetal anticonvulsant syndrome, SJS, Vit D deficiency, osteomalacia, drug fever, hepatotoxicity, nystagmus, death
Uses of carbamazepine bipolar disorder, chronic pain syndromes, trigeminal neuralgia, seizures
ADRs of carbamazepine SJS, Bone marrow suppression, drug fever, Vit D deficiency, osteomalacia, neural tube defects, IUGR
Uses of Valproic acid mania associated with bipolar disorder, migraine prophylaxis
ADRs of Valporic acid Hepatotoxicity, Hepatic failure, neural tube defects, increased riks of impaired cognitive function at 3 years
Uses of Gabapentin postherpetic neuralgia
ADRs of Gabapentin sedation
Uses of Lamotrigine manage/ treat bipolar disorder
ADRs of Lamotrigine Rash; SJS/TEN
Cushings triad is HTN, respiratory depression & bradycardia
Cushings triad (reflex) relates to Brain stem compression
Close contacts of patient with bacterial meningitis are given Rifampin
Drug of choice for absence or petit mal seizure Ethosuximide or valproic acid
Normal pressure hydrocephalus presents with Dementia, gait disturbance & urinary incontinence
Created by: duanea00