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Clin Med- Misc
Neuro
189
Medical
Graduate
09/30/2018

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Term
Leukoariosis
Definition
Deep white matter disease (due to multiple small blood vessel infarcts- HTN, diabetes, hyperlipidemia)
Gait issues (gait pathways pass through here- close to ventricles)
Term
Lacunar infarcts
Definition
small vessel infarcts affecting pons and basal ganglia
Term
Imaging results in vascular dementia?
Definition
Cortical infarcts
Leukoariosis (white matter disease)
Lacunar infarcts
Term
Tau?
Definition
Neurofibrillary tangles w/in neurons
Associated w/ Alzheimers
Term
Beta amyloid?
Definition
Protein buildup in extracellular space surrounding neurons- affects their communication
Seen in Alzheimers
Term
Imaging in Alzheimers?
Definition
Hippocampal atrophy (responsible for memory loss)
Parietal lobe/cingulate gyrus atrophy (responsible for visuospatial symptoms)
Corpus callosum atrophy (due to parietal lobe atrophy)
PET scan hypometabolism of glucose
Florbetapir- tags beta amyloid- loss of differentiation b/w white and gray matter
Term
What protein are Lewy bodies comprised of?
Definition
Alpha synuclein
Term
Why is Parkinsonism associated w/ diffuse Lewy Body dementia?
Definition
Lewy bodies in substantia nigra of brainstem- major source of dopamine for basal ganglia -> movement disorders
Term
Tx for Alzheimers?
Definition
Cholinesterase inhibitors
NMDA antagonists- block influx of Ca++ into cell (e.g. memantine)
Term
Tx for vascular dementia?
Definition
Prevent strokes- antiplatelet (ASA, clopidogrel), statins, BP or glucose control
Term
Why do we avoid neuroleptics in DLBD?
Definition
Can exacerbate Parkinsonism
Term
Tx for DLBD?
Definition
Cholinesterase inhibitors
(?) Carbidopa/levidopa
Term
Which pathology involves tau and TDP-43 protein?
Definition
frontotemporal lobe degeneration
Term
Behavioral variant of FTLD- where do tau proteins collect?
Definition
prefrontal cortex
Term
Criteria to dx "possible" bvFTD
Definition
At least 3 of the following:
Early (in the disease process) behavioral disinhibition
Early apathy or inertia
Early loss of sympathy or empathy
Early compulsive/ritualistic behavior (new onset)
Late hyper-orality/dietary changes
Executive/generation (coming up w/ a word) deficits, with sparing of memory and visuospatial functions
Term
Average age of presentation with FTD?
Definition
50s or 60s
Term
Behavioral disinhibition maps where?
Definition
Orbital frontal cortex
Term
Apathy/abulia maps where?
Definition
Medial portion of frontal lobes
Term
OCD-like behaviors map where?
Definition
Cingulate cortex
Term
Hyper-orality maps where?
Definition
Amygdala
Term
Imaging in FTD
Definition
Atrophy of frontal and temporal lobes
PET scan- hypometabolism of glucose in anterior frontal and temporal lobes
Term
3 key words w/ Parkinson's?
Definition
Bradykinesia, tremor, rigidity
Term
3 key words w/ Huntington's?
Definition
Choreiform movements, psychiatric, dementia
Term
Key psychiatric symptom of HD?
Definition
Irritability
Term
Allodynia
Definition
Feeling pain from a non-painful stimulus (e.g. sheet brushing your foot)
Term
Hypesthesia
Definition
a prolonged pain from a painful stimulus like getting poked with a pin that lingers for a long time.
Term
Features of inclusion body myositis?
Definition
MC in males > 50
Can be asymmetric
Attacks quads and forearm flexors first
Vacuolar inclusions on histology
Term
Gower's sign?
Definition
"Climbing up the legs" to get up off the floor
Term
cytoalbuminologic dissociation
Definition
Normal cell count, elevated protein
In csf, associated w/ Guillain Barre
Term
pathophysiology of GB?
Definition
Viral infection - anti ganglioside antibodies - muscle weakness develops over 2 -4 weeks then remits
Term
TX of GB?
Definition
ICU admit
IVIG and plasmapheresis
Monitor respiratory function
Physical therapy
Term
Avg age of onset of ALS?
Definition
55
Term
Sialorrhea
Definition
Excess salivation
Associated w/ ALS
Term
El Escorial/Awaji criteria of diagnosing ALS?
Definition
UMN and LMN deficits in 3/4 areas:
Head
Neck and arms
Thoracic
Lumbar (lower back & legs)
Term
PMA
Definition
Progressive muscular atrophy- purely lower motor neuron form of ALS
Term
PLS
Definition
Primary lateral sclerosis- purely upper motor neuron form of ALS
Term
Most common gene associated w/ ALS?
Definition
Chromosome 9 orf (open reading frame) 72
Term
2 treatments for ALS?
Definition
Riluzole- inhibits glutamate release
Edavarone- free radical scavenger
Term
Post-ictal Todd's paralysis?
Definition
Transient unilateral weakness following a seizure (typically resolves w/in 48 hrs)
Term
Abulia
Definition
An absence of willpower or an inability to act decisively, as a symptom of mental illness
Term
Transcortical motor aphasia
Definition
Pt not able to say what they want to say, but are able to repeat (lesion higher up than Broca's)
Term
Transcortical sensory aphasia
Definition
Looks like Wernicke's aphasia but pt is able to repeat (lesion higher up)
Term
Which artery primarily supplies the pons?
Definition
Basilar
Term
Contents of alpha granules of platelets?
Definition
Fibrinogen, VWF
Term
Contents of dense granules of platelets?
Definition
ADP, ATP, Ca++, histamine, serotonin
Term
Where are all procoagulants synthesized?
Definition
Liver (exception: VWF)
Term
Where is VWF synthesized?
Definition
Megakaryocytes & endothelial cells
Term
Function of factor X?
Definition
Converts prothrombin --> thrombin
Term
What does thrombin do?
Definition
Converts fibrinogen --> fibrin
Term
Which involves Tissue Factor (TF): extrinsic or intrinsic pathway?
Definition
Extrinsic
Term
2nd gen secretagogues?
Definition
Glipizide, Glimepiride, Glyburide
Term
First line therapy in diabetes management?
Definition
Biguanides (aka metformin)
Term
MOA of sulfonylureas (like glipizide)?
Definition
Bind to/close K+ channels on surface of beta cells --> depolarize cell --> influx of Ca++ --> increased fusion of insulin vesicles w/ cell membrane --> increased secretion of insulin
Term
Metformin MOA?
Definition
Decreases liver production of glucose, increases peripheral uptake of glucose via GLUT4 transporter
Term
Digoxin MOA?
Definition
Inhibits Na/K pump in heart cells --> ^ in intracellular Na --> ^ in intracellular Ca++ --> ^ contractility --> improved CHF
Term
Dipyridamole MOA?
Definition
Inhibits phosphodiesterase enzymes that break down cAMP --> ^ in cellular cAMP --> blocking platelet aggregation
Term
What is CPP and what should it be?
Definition
CPP = MAP (mean arterial pressure) - ICP (Intracranial pressure) >/= 70
Term
How far do we try to reduce SBP in a stroke patient?
Definition
Below 160
Term
Gram stain for listeria?
Definition
G+ bacilli
Term
Gram stain for S. pnumoniae?
Definition
G+ diplococci
Term
Gram stain for N. meningitidis?
Definition
G- diplococci
Term
What area of the brain is typically involved in deja vu epileptic auras?
Definition
Temporal lobe
Term
What distinguishes migrainous from epileptic auras?
Definition
Migrainous- several minutes
Epileptic- few seconds
Term
Are epileptic auras usually simple or complex hallucinations?
Definition
Simple- such as metallic taste, coloured spots, tinnitus, tingling
Term
Cysticercosis?
Definition
Pork tapeworm
Organism = T. solium
Term
What clinical evidence could indicate history of nocturnal seizures?
Definition
bed wetting, tongue biting, blood on the pillow, early morning headache, or “hangover” without alcohol
Term
Which is associated w/ seizures: hyper or hypothyroidism?
Definition
Hypo
Term
Factors conferring highest risk of recurrence after first seizure?
Definition
Nocturnal seizures, prior brain lesion causing the seizure, EEG w/ epileptiform abnormalities (spikes or waves), significant brain imaging abnormality
Term
Rich foci are associated w/ what type of meningitis?
Definition
TB meningitis
Term
Jolt accentuation?
Definition
Headache worsens when patient vigorously shakes their head
Term
Brudzinskis sign?
Definition
Pain/hip flexion with flexion of the neck
Term
Kernig's sign?
Definition
Pain/resistance to leg extension with hip flexion
Term
What causes petechial rash in meningitis pts?
Definition
Meningococcemia (due to N. meningitidis)
Term
What two chemicals are secreted by basophils?
Definition
Histamine and heparin
Term
Which WBC turns into macrophages in the tissue?
Definition
Monocytes
Term
Which are longer-lived: neutrophils or monocytes?
Definition
Monocytes- able to renew their lisosomes
Term
Horner syndrome is associated w/ what type of headache?
Definition
Cluster
Term
Sxs of Horner syndrome?
Definition
Miosis
Ptosis
Anhydrosis
Term
What headache medication class targets serotonin 1d receptors intracranially and on the trigeminal nerve?
Definition
Ergotamines
Term
What headache med class targets 5HT-1d/1b receptors and is contraindicated in CAD/angina?
Definition
Triptans
Term
MOA of metaclopramide?
Definition
dopamine antagonist
Term
First-line tx of cluster headaches?
Definition
100% O2
Term
Cluster HA prophylaxis?
Definition
CCBs (verapamil)
Term
Migraine prophylaxis?
Definition
Anticonvulsants (depakote, topiramate)
B-blockers (propranolol)
Frovatriptan (menstrually-associated migraine)
Butterbur herbal
Selective calcitonin gene-related peptide antibody (erenumab-aooe)
Term
MOA of acyclovir?
Definition
Competitively inhibits viral DNA polymerase
Term
MC cause of fungal meningitis?
Definition
Cryptococcus
Term
Tx for cryptococcus?
Definition
Fluconazole
Term
Cause of "pink, lacy" rash in meningitis?
Definition
Viral
Term
CSF workup in meningitis?
Definition
1) Culture (gold standard)
2)Gram stain
3) Latex agglutination test for antibodies
4) PCR for virus
5) CRP (most likely bacterial)
Term
Prophylaxis for close contacts of N. meningitidis?
Definition
Rifampin, cipro, ceftriaxone
Term
Drugs that can cause meningitis?
Definition
NSAIDS, bactrim
Term
Pathophys of subdural empyema?
Definition
Thrombophlebitis of sinus venous drainage
Osteomyelitis
Neurosurgery
Term
First-line tx for migraine?
Definition
Triptans (5HT-1b/1d agonists)
Term
What is midrin?
Definition
acetaminophen, isometheptene and dichloralphenazone
Term
Methysergide?
Definition
Ergot-derived HA medication (5HT-2b antagonist)
Term
MC nontraumatic cause of SAH?
Definition
Aneurysm e.g. Berry
Term
Temporal arteritis associated w/ what disease state?
Definition
Polymyalgia rheumatica
Term
Work-up of pt w/ suspected temporal arteritis?
Definition
Start corticosteroids right away
Arterial biopsy gold standard to dx
Term
What is another name for idiopathic intracranial hypertension?
Definition
Pseudotumor cerebri
Term
LP findings in pseudotumor cerebri?
Definition
High opening pressure, normal CSF
Term
Glasgow coma scale findings?
Definition
Normal- 15
Comatose <8
Unresponsive <3
Term
What is indicated in pinpoint pupils w/o reaction to light?
Definition
Pontine injury
Term
What is indicated by pinpoint pupils that do react to light?
Definition
Narcotics
Term
What causes Wernicke encephalopathy?
Definition
Thiamine (vit B1) deficiency
Term
What can Wernicke encephalopathy progress to?
Definition
Korsakoff syndrome (chronic amnesia, confabulation, impaired learning)
Term
MC 3 causes of TBI?
Definition
1) Falls
2) MVA
3) Hitting an object or getting hit
Term
Normal ICP?
Definition
2-20 mm Hg
Above 60 damages neurons
Term
Cerebral Perfusion Pressure (CPP)?
Definition
MAP - ICP
Normal 60-80 mm Hg
Term
PE findings consistent w/ basilar skull fracture?
Definition
Battle's sign, raccoon eyes, CSF leak, hemotympanum
Term
Glabellar reflex?
Definition
Glabellar reflex (also known as the "glabellar tap sign") is a reflex elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson's disease
Term
Astereognosis?
Definition
the inability to identify an object by active touch of the hands without other sensory input
Term
Dysdiadochokinesia?
Definition
an impaired ability to perform rapid, alternating movements
Term
What are highest risk factors associated w/ seizure recurrence after unprovoked first seizure?
Definition
1) Prior brain lesion causing the seizure
2) EEG w/ epileptiform abnormalities (spikes or sharp waves)
3) brain imaging abnormality
4) nocturnal seizure
Term
What is the most common type of "first seizure"?
Definition
Febrile seizure
Term
What is myoclonus?
Definition
Sudden irregular jerk caused by involuntary muscle activity, involving the trunk or one or more limbs
Term
What distinguishes an epileptic aura?
Definition
Brief- last only a few seconds
Simple sensory- metallic taste, tinnitus, colored spots, tingling (rarely complex hallucinations)
Deja vu/jamais vu- intense feeling of the familiary (associated w/ temporal lobe seizure)
Term
Clonus
Definition
Regular shaking
Term
Tonus
Definition
Rigid stiffening
Term
Dystonic seizure
Definition
Spasm
Term
Simple partial motor seizure
Definition
Focal motor seizure w/o loss of consciousness or awareness
Can be clonic, tonic, or dystonic, usually lasts a few seconds
Term
What are the seizures w/ loss of consciousness
Definition
Absence, complex partial, complex generalized, tonic clonic
Term
What type of seizure used to be called "petit mal"?
Definition
Absence
Term
What type of seizure typically starts with a cry, then subsequent loss of tone and fall?
Definition
Tonic clonic
Term
Which is more commonly preceded by nausea or sweating: seizure or syncope?
Definition
Syncope
Term
status epilepticus
Definition
a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them.
Term
With what disorder is pelvic thrusting associated?
Definition
Non-epileptic attack disorder
Term
Signs/symptoms of nocturnal seizure?
Definition
Bed wetting, blood on pillow, "hangover" without drinking
Term
First-line tx of first seizure?
Definition
Benzodiazepines
Term
Components and scoring of Glasgow Coma Scale?
Definition
Eye opening, best motor response, best verbal response.
Best score 15, worst 3
Term
Time window for tPA and mechanical thrombectomy?
Definition
tPA: <4.5 hrs from onset
Thrombectomy: <24 hrs from onset
Term
Test to screen for MG?
Definition
edrophonium injection
Term
pyridostigmine MOA?
Definition
AChE inhibitor
Term
What disease is characterized by progressive neuron degeneration with neurons replaced by gliosis?
Definition
ALS
Term
Intracellular bunina bodies are associated w/ what disorder?
Definition
ALS
Term
Drug used to tx ALS and its MOA?
Definition
Riluzole
Glutamate blocker
Term
What does dysprosodic mean in regards to speech?
Definition
Monotonous
Term
What NIH scale score constitutes severe stroke?
Definition
21-42
Term
Dipyrimadole MOA and indication?
Definition
Phosphodiesterase inhibitor- blocks uptake and metabolism of adenosine by erythrocytes, platelets and vascular endothelial cells.
Vasodilator/blood thinner to prevent ischemic events
Term
MOA of TPA (tissue plasminogen activator aka alteplase)?
Definition
Thrombolytic agent: Initiates local fibrinolysis by binding to fibrin in a thrombus and converts entrapped plasminogen to plasmin.
Term
Cerebral Perfusion Pressure (CPP) formula?
Definition
MAP - ICP (needs to be greater than 70)
Term
Digoxin MOA?
Definition
Inhibits Na-K ATPase
Term
Statin MOA?
Definition
Inhibits HMG-CoA reductase, reducing cholesterol synthesis
Term
Clopidogrel MOA?
Definition
Irreversibly binds P2Y12 receptors on platelets - inhibits platelet aggregation
Term
Colesevelam MOA?
Definition
Bile acid sequestrant
Term
dyskinesia
Definition
Involuntary spasms, repetitive motions or abnormal voluntary movement
Term
Examples of dopamine antagonists?
Definition
Typical antipsychotics (haloperidol, fluphenazine, chlopromazine)
Atypical (less) (Olanzapine, clozapine, risperidone)
Antiemetics (prochlorperazine, promethazine, metoclopramide)
Term
What chromosome houses the mutation for Huntington's?
Definition
4
Term
What type of tremor is relieved with EtOH ingestion?
Definition
Essential (benign familial) tremor
Term
What disorder is associated w/ resting tremor/pill rolling?
Definition
Parkinson
Term
Festination
Definition
Increased speed while walking
Seen in PD due to postural instability
Term
Examples of COMT inhibitors?
Definition
entacapone, tolcapone
Term
Which of the following presents with decreased DTR: Guillain-Barre or MG?
Definition
GB
Term
Gold standard diagnostic test for MS?
Definition
MRI w/ gadolinium
Term
MOA of triptans and ergotamines?
Definition
5HT-1B and 1D agonists --> vasoconstriction
Used as abortive tx of migraines
Term
Prophylactic tx of migraines?
Definition
B-blockers, Ca-channel blockers, TCAs, anticonvulsants, NSAIDs
Term
1st tx of acute cluster HA?
Definition
O2
Term
Prophylaxis for cluster HA?
Definition
Verapamil
Term
Acetazolamide MOA
Definition
Carbonic anhydrase inhibitor (acts in the PCT of the nephron)
Term
CT findings in Alzheimers?
Definition
Cerebral cortex atrophy
Term
Alzheimers tx?
Definition
AchE inhibitors (donepezil, tacrine, rivastigmine, galantamine)
NMDA antagonist (memantine)
Term
What is the MC primary CNS tumor in adults?
Definition
Glioblastoma multiforme
Term
What type of astrocytoma is glioblastoma?
Definition
Grade IV
Term
Hemangioma
Definition
Abnormal buildup of blood vessels in the skin or internal organs
May secrete EPO --> 2ary polycythemia
Term
anosognosia
Definition
a deficit of self-awareness, a condition in which a person with some disability seems unaware of its existence
Term
ABCD2 to assess CVA risk?
Definition
Age > 60
BP > 140/90
Clinical features (speech disturbance, unilateral weakness)
Duration of TIA
Diabetes
Term
TIA tx?
Definition
Aspirin + dipyridamole or clopidogrel
Term
CT scan in lacunar infarct?
Definition
Small punched out hypodense lesions
Term
Tx for elevated ICP?
Definition
Mannitol
Term
MC mechanism of epidural hematoma?
Definition
Temporal bone fracture --> middle meningeal artery hemorrhage
Term
MC mechanism of SAH?
Definition
Berry aneurysm (Circle of willis)
Term
MC mechanism of subdural hematoma?
Definition
Blunt trauma (venous bleed)
Term
Kernig's sign
Definition
Think "kermit the frog"
Inability to straighten knee w/ hip flexion
Term
Brudzinskis sign
Definition
Neck flexion produces hip/knee flexion
Term
MC cause bacterial meningitis in neonates?
Definition
Group B strep (strep agalactiae)
Term
MC cause of viral meningitis?
Definition
Enterovirus family (e.g. echovirus, coxsackie)
Term
MC cause of encephalitis?
Definition
HSV-1
Term
Tx for absence seizures?
Definition
Ethosuximide
Term
Tx for tonic clonic seizure?
Definition
VPA, phenytoin, carbamazepine, lamotrigine
Term
Tx for status epilepticus?
Definition
Benzos, then phenytoin, then phenobarbital
Term
MOA of benzos?
Definition
Increase GABA
Term
Phenytoin MOA?
Definition
Blocks Na channels in CNS
Term
Adverse fx of phenytoin?
Definition
Gingival hyperplasia, SJS, hirsutism
Term
Barbiturates MOA?
Definition
Bind allosterically to GABA receptors to enhance GABAergic inhibition in CNS
Term
Ethosuximide MOA?
Definition
Blocks Ca++ channels --> motor cortex depression
Term
Adverse fx of VPA?
Definition
Pancreatitis, hepatotoxicity
Term
Which anti epileptic drug (AED) is also used to treat diabetes insipidus and may cause hyponatremia and blood dyscrasias?
Definition
Carbamazepine
Term
Which AED can cause nephrolithiasis?
Definition
Topiramate
Term
Which AED can cause osteoporosis?
Definition
Phenobarbital
Term
What class of AEDs is most associated w/ sedation?
Definition
Benzos
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