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Step2: Neuro

Neuro 1

QuestionAnswer
Which tract conveys motor from cortex to head & neck? Corticobulbar
Which tract conveys postural adjustments and head movements? Vestibulospinal
Which CN is responsible for: eyelid opening? Oculomotor (CN III)
Which CN is responsible for: taste from anterior 2/3 of tongue? Facial (CN VII)
Which CN is responsible for: carotid body? Glossopharyngeal (CN IX)
A LESION to which area of brain causes: Contralateral hemiballismus? Subthalamic nucleus (use this for Parkinson's Rx)
A LESION to which area of brain causes: Eyes look towards lesion? Frontal eye field
A LESION to which area of brain causes: Eyes look away from lesion? PPRF
A LESION to which area of brain causes: Coma? Reticular Activating System
A LESION to which 3 areas of brain causes: poor repetition, poor comprehension, poor vocal expression? Repetition: arcuate fasciculus; Comprehension: Wernicke's; Vocalization: Broca's
A LESION to the non-dominant Parietal lobe (usually Right) causes what? Hemispatial neglect syndrom
A LESION to the dominant Parietal lobe (usually Left) causes what? Agraphia & Acalcula
What LESIONS cause resting tremor vs. intention tremor? Resting: Basal ganglia (Parkinson); Intention: Cerebellar
What LESION to the brain causes dysarthria? Cerebellar vermis
Top 3 causes of bacterial meningitis in <1mo baby? What's the Rx? E Coli, GBS, Listeria. Rx: amp + ceft/gent
Top 3 causes of bacterial meningitis in 1mo-60yo? Rx of these causes? Strept Pneumo, N. Meningitidis, Staph Aureus. Rx: ceft/cefo, vanco, dexamethosone
Top 4 causes of bacterial meningitis in 60yo+ and alcoholics? Rx for these causes? Strept Pneumo, Listeria, N. Meningitidis, Gram (-) bacteria. Rx: amp, cefo/ceft, vanco, dexamethosone
Why give dexomethosone with or before ABx when treating bacterial meningitis? Helps improve neurological sequelae. For kids, helpful in HiB and NM infections. For adults, helpful in Strept Pneumo infections.
For suspected bacterial meningitis, in what order do you do labs/radiology? Neuro exam > LP > CT. If showing severe defecits, skip LP (may cause uncal herniation) and go straight to CT.
Rifampin is given to contacts of bacterial meningitis patient to protect from what infectious agents? N. Meningitidis and HiB
MCC of fungal meningitis? How do you stain? How do you Rx? Cryptococcus in HIV patients. Stain with India Ink. Rx with ampho B intrathecally.
Complications of bacterial meningitis in children (list of 4)? 1) Hearing loss 2) Seizures 3) Spastic paralysis 4) Mental retardation
MCC of asceptic (viral) meningitis? Enterovirus (Coxsackie and Human enterovirus)
3 labs for viral meningitis? LP, viral culture, viral Ag panel
Four components of Rx for viral meningitis? Acetominophen (pain), IV fluids, Empiric ABx (until bacterial r/o), Acyclovir (until HSV r/o)
Presentation of West Nile Virus encephalitis? Maculopapular rash w/ flaccid paralysis
Hallmark of viral encephalitis presentation? Change in mental status
HSV encephalitis typically seen in which brain area on CT? Parietal lobe
Reye's syndrome in kids causes decreased _________ on blood labs. Glucose (d/t liver damage)
Six step mgmt of Reye's syndrome? 1) Discontinue ASA 2) ICU admission for C/P monitoring 3) maintain normal Glucose levels [very impt!] 4) maintain isovolemia 5) Reduce brain swelling 6) Phenytoin [if seizures, NOT prohpylactically]
Rhomberg test checks function of __________. Vestibular (CN VIII) apparatus, NOT cerebellum.
T/F: culturing in viral encephalitis is recommended. False. Definitive Dx is by biopsy (but not practical). CT/MRI may show lesion.
ALS has what type of paralysis? Both spastic and flaccid
Poliomyelitis affects what tract? What type of paralysis does it cause? Affects ventral horn (motor neurons), causing flaccid paralysis.
Tabes Dorsalis is a sequela of what infection? What tract does it affect, leading to what symptoms? D/T tertiary syphilis. Affects Dorsal columns, causing pain and proprioception (gait) impairment.
Spinal artery syndrome spares what region of spinal cord? Dorsal columns
B12 deficiency damages what tracts? Dorsal columns, corticospinal tract (b/l loss of vibration, etc and b/l spastic paralysis of legs then arms)
Syringomyelia affects what region of spinal cord? Causes what symptoms? Affects ventral white commissure, then ventral (motor) horn. Causes b/l loss of pain/temp 1 level below, then flaccid paralysis @ level of lesion
Brown-Sequard syndrome affects what part of spinal cord? One entire half.
What lab do you do to confirm brain abscess? Culture during biopsy by needle aspiration. Biopsy is CT guided
What radiology do you do for brain abscess? What does it look like? MRI (more detailed than CT). Shows ring-enhancing lesion d/t capsule.
Brain abscess is treated with ABx, ________, and surgical drainage. Corticosteroids
LP picture of poliomyelitis resembles that of ________________. Viral meningitis
Labs for polio? Polio-specific AB, LP, viral culture (throat, stool, or CSF)
What is the benefit of I/M polio vaccine over oral? I/M vaccine is killed, so no risk of infection with virus.
Rabies causes hydrophobia due to _____________. Laryngospasm
CSF picture of viral meningitis (WBCs, Pressure, Glc, Protein)? WBCs: lymphocytes; Pressure: slightly increased; Glc: normal; Protein: normal
CSF picture of bacterial meningitis (WBCs, Pressure, Glc, Protein)? WBC: PMNs; Pressure: greatly increased; Glc: low; Proteins: high
CSF picture of fungal meningitis (WBCs, Pressure, Glc, Protein)? WBC: lymphocytes; everything else same as bacterial
3 steps after Rabies is suspected? 1. catch and observe suspected causative animal 2. if appearing infected, kill animal and test brain for Negri bodies 3. viral testing in patient (CSF, skin, serum)
Rx of Rabies? Clean wound well, rabies immunoglobulin AND vaccine patient if animal is infected/suspected of carrying rabies
Created by: jsad
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