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Flashcards in Neurology Deck (280)
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121

Vertigo with sudden onset dizziness, dysarthria, diploppia and weakness

Vertebrobasilar ischemia

122

Vertigo post URI, horizontal nystagmus dissappears on visual fixation

Vestibular neuritis - labryrinthitis)

123

MCC vertigo

Benign positional vertigo

124

Tinnitis with gradual onset hearing loss, whisper test decreased - tuning for on mastoid doesn't elicit resposne - tuning for on forehea dwith no loaclization - audiology with high freq hearing loss

Presbycusis

125

MCC dementia

Alzheimer's dz
60yo cognitive impairment, poor short term membory, can't name names
paranoit delusions
CT/MRI - brain atrophy - dilated ventricles
inc'd B amyloid precursuor protein - inc'd presenilin activity, APo protein E4
Neurofibrillary tangles - protein Tau (microtubule)

126

Treatment dementia

MMSE 21-25 - cholinergic augmentation (anticholinesterase), donepezil, galantamine, rivastigmine
MMSE 11-20 - cholinergic augmentation plus NMDA antagonist (memantine)
MMSE <11 - severe dementia - consider palliative care - d/c meds

127

Effect of cholinesterase inhibitor

Improvement of neuropsychiatric score

128

Pt with alzheimers - family asks about memantine - advice?

SLOWS progression of dementia

129

Pt with alzheimer's on donepezil - has hip surgery - post surgery agitated and confused - dx?

Post op delirium

130

82yo M with alzheimers for several years - has been getting donepezil and memantine, chlorthalidone for HTN, metformin for DM and nortriptylinefor depression getting more agitated - wtd?

d/c anti-cholinergics

131

Donepezil, galantamine and rivastigmine are choinesteras inhibitos used to treat dementia - aw?

Syncope

132

Who is more likely to experience sever disability in performance of daily living - cancer or dementia pt

Advanced dementia

133

62yo sales exective pw forgetfullness - MMSE 27/30 father with alzheimers dx?

Mild cognitive impairment
wtd? Neuropsych eval
Reasess in 1yr - rate of progression to alheimers 15%/yr
Tx: improve cognitive fxn with 6 month program physical activity and cognitive training

134

S/E Ginkgo

inc'd bleeding time

135

75yo Pt brought in by son - father behaving irrationally - father thinks son is imposter and beign kept in prison - looks like home - gets lost in mall freqently now doesn't go - mild tremor soem rigidity - urinary and fecal inctinecne in recetn months - CTH brain atrophy and dilation of ventricles dx?

Alzheimer's dz
tx: not very effective
Acetylcholinesterase inhibitor, NMDA rct antagonist

136

Pt with dementia, parkinsonian sx of brady kinesia and postual instability, VISUAL HALLUCINATIONS, no resting tremor, extremem regigity, cytoplasmic inclusion bodies in subcortical tissue

Dementia with lewy bodies (lions in backyard...)

137

35yo pt with dementia father with dementia at age 40 dx?

Huntington's dz

138

Memantine

Alzheimer's dz

139

Loss of interest, disinhibition, urinates in neighors lan, hyperseuxal

Fronto-temporal dementia

140

Contacminated corneal transplants and growth hormone

Creutzfeldt-jakob dz

141

EEG intermittent sharp waves with slow background

Creutzfeldt-jakob dz

142

65yo M chronic HTN, hx CVA 3 ya with rapid onset dementia no problem naming names ataxia nd diplopia, extensor reflex, no sensory loss - CT scan multiple no-enhancing hypodense lesions

Multi-infarct dementia
tx: optimize CVA prevention (smoking cess, statins, ASA etc)

143

65yo M onset of memory loss noticed by family, difficulty naming names, no motor sx - paranoid delusions

Alzheimer's dz

144

80yo F pw dementia, urinary incotinence wid based gait, CT scan enlarged ventricles and sulci NOT enlarged

Normal pressure hydrocephalus
tx: VP shunt

145

55yo M onset of dementia with RAPID deterioration, myoclonic jerks, NO incontinence

Creutzfeldt-jakob dz

146

Pt sees roaring lions/bears, stiffness, tremor

Dementia with Lewy bodies
motor features of parkinson's
bizarre visual hallucinations
Tx: sx tx of parkinsonian sx, anti-psycotics

147

Multiple Sclerosis

Demyelination of white matter in brain and spinal cord
Demyelination - plaques in the white matter on MRIwGAD
Brain- Optic nerve - optic neuritis
Medial longitudinal fasciculus - Internuclear ophthalmoplegia - one eye can't pass midline (both eyes can't look same way)

Spinal cord - > Dorsal columns: Sensory changes, vibration and position sense loss
-> corticospinal tracts - MOTOR sx - wk, spacsiticy, hyperreflexia

148

Optic Neuritis

Inflammation of Optic Nerve
Subacute decrease in vision +- periocular pain
Visuion blurry post excerc or heat/smoking or stress
Relative afferent pullilary defect
Tx: IV methylprednisone

149

Other presentations of MS

Bladder dysfxn
Bowel dysfxn
Sexual dysfxn
Trigeminal neuraligia
Cognitive dysfxn (thinning of corpus callosum
Spasticity - carbamazepime helps
Fatigue - tx with Amantadine
NO seizures
No aphasia
No h/a

150

Dx of MS

Clinical presentation
Best imaging - Flare - MRI inc'd T2 signal dec'd T1 signal
Enhancement with Gad in active lesions
If MRI inconclusive - evoked potential studies - conduction velocities
CSF: Cell 2 IgG olgoclonal bands suggestive of MS