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Step III

Step III - Neuro 2

QuestionAnswer
Resting tremor, >50yo, Small handwriting. Dx Parkinson
Tremor ↑ w/ activity but improves w/ EtOH, Difficult handwriting. Dx Essential tremor
Parkinson sx + Autonomic insufficiency. Dx Shy Drager syndrome
Parkinson like sx, Renal + liver + CNS dz, Yellow rings in cornea. Dx Wilson’s dz
Dance mvts, Dementia, Pysch c/o, 30-50yo. Dx Huntington chorea
Transmission of Huntington chorea AD
Neuro signs separated by space and time ie parasthesia in LE, 1 yr later visual . Hot shower worsens sx MS
Initial Diagnostic study for MS MRI brain + SC
MC 1⁰ sx of MS LE parasthesia
What is the classic pt CC in dr office for MS pt c/o visual change
Demylx white matter, Muscle weakness w/ continued use MG
Diagnostic study for MG EMG
What Abs are made in MG Nicotinic Ach-R
Rapidly ascending BILAT muscle weakness x4 ext GB
Diagnostic study for GB EMG
Progressive muscle weakness, UMN + LMN, Impaired speech, Fasciculations (denervation) ALS
Diagnostic study for ALS EMG
Lip smacking, Rapid eye blinking, Depersonalization (consciousness impaired) Absence seizure
Tx for absence seizure Ethosux only
Diagnostic study for absence and what does it show EEG: 3 second spike and generalized wave D/C
Impaired consciousness, Involuntary mvts, Postictal confusion + Temporal lobe c/o eg: Olfactory, auditory, visual hallucinations Complex partial seizure
Tensing/rigid + Repetitive mvts + Postictal + Tongue biting, Loss of urine/bowel Tonic clonic
What is the difference b/t tonic clonic and syncope presentation does NOT show loss of bladder control
Hemangiomas in brain, sp, retina Von-Hippel-Lindau
↑phosphokinase, Absent DTRs, Atrophy muscle Poliomyelitis
Trauma causing hemi-section S.C. is called Brown Sequard
What are the IPSILAT findings in Brown Sequard Hemiparesis (corticospinal tract), Loss vibration, Loss positional sense (dorsal columns)
What are the CONTRALAT findings in Brown Sequard Pain + temp (spinothalamic)
“cape like”, UE areflexia, B/L loss pain + temp Syringomyelia
Tx for Syringomyelia Decompression, Drainage, Shunt placement
Diagnostic study for Syringomyelia MRI
What type of herniation is Syringomyelia a/w ARNOLD CHIARI herniation
 reflexes, Unsteady gait, Formication,  proprioception, B/L Argyl pupil (no constrictx, + accom) Tabes dorsalis
What disease is a/w tabes dorsalis 3⁰ syphilis
Pt immigrant w/ no vaccx hx, Sudden asymmetric weakness, Flaccid paralysis, NO DTRs Poliomyelitis
Chorea, Dementia, Pysch Huntington
What DNA abnL found in Huntington dz DNA CAG repeats
What is the time frame that distinguishes TIA from strokes TIA <24hr
What the two causes of TIAs Emboli OR thrombosis (not hemorrhage)
Aphasia, neglect/apraxia, and profound UE weakness is linked to what aa MCA
Eyes deviate toward or away from lesion in MCA stroke TOWARD
What does prosopagnosia mean Can’t recognize faces
Contralat homo hemianopsia w/ macular sparing + can’t recognize faces liked to what aa PCA
Vertigo, N/V, labile BP, vertical nystagmus, ataxia, dysarthria, sensory change in scalp and face, “drop attack” linked t what aa vertebrobasilar aa
Absence of cortical (motor) deficits, hemiparesis (face), ataxia, parkinsonian signs Lacunar infract
Transient loss of vision in one eye is called what and linked to what aa Amaurosis fugax; ophthalmic aa
What is the best initial Diagnostic study for TIA/stroke CT w/o contrast
What are the CI to thrombolytic tx for stroke Surgery or active bleeding <6wks, Aortic dissection, Active internal bleeding, Pericarditis, h/o hemorrhagic stroke, ischemic stroke <3mos, BP > 180/110, Recent traumatic CPR <3wks, presence neoplasm/mass, brain trauma or brain surgery <6mos
In what time frame can thrombolytics be given to stroke pts w/o CI 3 hrs from onset of S/S
What will the CT show in first several days for NON-hemorrhagic stroke NORMAL CT
How many days does it take for MRI and CT to approach 95% sensitivity in detecting NON-hemorrhaghic stroke CT: 3-5 days; MRI: 24hrs
What is the best initial tx for stroke pts past the thrombolytic time frame ASA
If stroke pt is already on ASA and presents after thrombolytic time frame what can be used Dipyridamole OR clopidogrel
Once imaging and thrombolytics are given to pt what is the next goal of tx Find the cause of the stroke
What studies are indicated for ALL stroke/TIA pts to determine the etio Echo, EKG +/- Holter, carotid dopplers
If you find clots on ECHO for stroke pt what is the tx Warfarin +/- surgery of valve vegetation
When do you order a Holter monitor in stroke pt when EKG is nL
When would you do an endarterectomy for carotid stenosis in stroke pt >70% stenosis
When would you NOT do an endarterectomy for carotid stenosis in stroke pt 100% stenosis
Young pts who have stroke are caused by Vasculitis or hypercoag state
What is the BP goal for HTN stroke pt <130/80
What is the LDL goal for stroke pts <100
What is the stepwise tx plan for status epilepticus 1st: lorazepam, if seizures persists 10-20 mins later add fosphenytoin > Phenobarbital > gen anesthesia/pentobarbital
What initial tests are indicated in pt w/ seizure O2, Na, Ca, glucose, creatinine, Mg, CT head, UDS
If initial testing for seizures reveals nothing then what is the next test EEG
Generally first time seizures are not managed with chr anti-seizure meds. In what cases would this be different Strong FHx, use of BDZ to stop seizure, abnL EEG
What are the first line chronic tx for status epilepticus Valproate, carbamazepine, lamotrigine, levetiracetam, phenytoin
Which 1st line chronic tx for status epilepticus cause skin conditions and SJS Lamotrigine
What are the 2nd line chronic tx for status epilepticus Phenobarbital, gabapentin
What is the chronic tx for absence seizures Ethosuximide
Orthostasis + festinating gait = Parkinson’s dz
What does hypomimia mean Mask face
What is still intact w/ Parkinson’s dz Cognition and memory
What is the tx for mild sx of Parkinson’s dz in pt <60 Anti-cholinergics eg hydroxyzine, benztropine
What is the tx for mild sx of Parkinson’s dz in pt >60 Amantadine
Which tx for severe Parkinson’s dz has the greatest efficacy Levodopa, carbidopa
Which tx for severe Parkinson’s dz has the least AE Dopa agonist (pramipexole, ropinerole, cabergoline)
If initial tx for severe PD does not control sx then what can be added COMT (-) eg tolcapone, entacapone OR MAOIs eg selegiline, resegiline
What is the tx for essential tremor Propranolol
What is the tx for PD tremor Amantadine
What should be ordered for all pts w/ memory loss B12 level, CT, T4/TSH, RPR or VDRL
Slowly progressive loss of memory exclusively in older pt >65yo w/ apathy. Years later imprecise speech. No motor or sensory focal deficits ALZ
What does CT show in ALZ Diffuse symmetrical cortical atrophy
What is the standard of care for tx ALZ Anticholinesterase meds eg donepezil, rivastigmine, galantamine >> memantine
Tx for Pick’s disease and response Same as ALZ (anticholinesterase) but less response
Pt <65 w/ rapidly progressive dementia and myoclonus CJD
Most accurate test for CJD Brain bx
Created by: DrINFJ