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Neuro DRx > 02a: HA, PNS disease > Flashcards

02a: HA, PNS disease Flashcards

1
Q

List the types of primary headache disorders. Star the most common.

A
  1. TTH (tension type HA)*
  2. Migraine
  3. Trigeminal autonomic cephalagias (TAC) - “cluster HA”
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2
Q

T/F: Most important part of HA diagnosis is imaging.

A

False - clinical hx then exam then (maybe) imaging/studies

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3
Q

Red flags in HA assessment.

A
  1. Sudden onset (thunderclap)
  2. New/worsening in old/immunocompromised pt
  3. Neck pain/stiffness, fever, confusion, rash
  4. Focal neuro deficits
  5. Exertional/positional
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4
Q

In patient with PHx of (X), thunderclap HA is a bit less worrisome/serious.

A

No PHx can make this less serious! ALWAYS take seriously

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5
Q

What are you even worried about with thunderclap HA?

A
  1. Acute bleed (aneurysm rupture, tumor bleed)

2. Acute blood clot in venous sinus

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6
Q

Which (primary/secondary) causes of HA are you worried about in older/immunocompromised patient?

A

Secondary;

Tumor, inflammatory (GCA), subacute infection (fungal, crypto, TB)

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7
Q

HA triggered by exertion may be symptom of (X).

A

X = vasculopathy or increased ICP

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8
Q

Pulsating HA more characteristic of (migraine/TTH).

A

Migraine

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9
Q

Unilateral location more characteristic of (migraine/TTH).

A

Migraine

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10
Q

HA not aggravated by walking/climbing stairs more characteristic of (migraine/TTH).

A

TTH

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11
Q

Migraine aura symptoms are (reversible/irreversible) and may involve:

A

Reversible (fully);

Vision, speech/language, brainstem, sensory, motor, retinal

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12
Q

T/F: Meeting diagnostic criteria for primary HA is sufficient to rule out secondary HA disorder.

A

False

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13
Q

Acute meds for both migraine and TTH:

A
  1. Acetaminophen
  2. NSAIDs
  3. Combo analgesics (excedrin)
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14
Q

Procedures for migraine and TTH:

A

Nerve block (lidocaine into trigeminal branches, occipital nerves and trigger points)

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15
Q

Acute treatment/drugs specific for migraine include:

A
  1. Antiemetics
  2. Triptans
  3. Ergotamine
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16
Q

Combo treatment (acute) for migraine typically includes:

A

Triptan, NSAID, and antiemetic

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17
Q

Patient presenting to ER with severe migraine HA should be treated with (IV/po):

A

IV;

NSAID (ketorolac), antiemetic, and IVF

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18
Q

You should take special care when prescribing migraine drugs, esp ergotamines, to which patient population?

A

Younger women (dangerous in pregnancy)

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19
Q

(X) meds can be used to prevent both migraines and TTH.

A

X = tricyclics

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20
Q

List some meds that can be used to prevent migraine (but not TTH).

A
  1. BB (propranolol)
  2. CCB (verapamil)
  3. SSRI
  4. Antiepileptic
  5. Botox…
21
Q

Polio clinically affects (UMN/LMN) with (painful/painless) (symmetric/asymmetric) (rigidity/weakness) of limbs.

A

LMN; painless

Asymmetric; weakness (and atrophy)

22
Q

List some autoimmune and toxic causes of DRG diseases (ganglionopathy).

A

Sjogren’s, vit B6 overdose

23
Q

List some infectious causes of DRG diseases (ganglionopathy).

A

VZV, Tabes dorsalis

24
Q

Radiculopathy is a disease of (X) structures and can be caused by structural issues such as:

A

X = spinal roots

Herniated disc, osteoarthritis, tumor

25
Q

Give an example of autoimmune spinal roots disease (radiculopathy).

A

Guillain-Barré Syndrome

26
Q

Weak knee extension, thigh adduction, and dorsiflexion. Depressed patellar reflex and decreased sensation to medial foreleg. Where is the lesion?

A 
L4 root (common to all symptoms);
Femoral, Obturator, and Peroneal nn (motor), patellar reflex, and saphenous n (sensory)
27
Q

T/F: Plexus injury is characterized by pain.

A

True - axilla/groin (very painful)

28
Q

Radiculoplexoneuropathy is disease of which structure(s)? Name a disease that can have this as complication.

A

Root, plexus, and nerve;

Diabetes (ischemic etiology)

29
Q

T/F: Demyelinating neuropathy is always inherited.

A

False - always acquired (ex: Guillian-Barré)

30
Q

Patient with recent Hx of “flu-like” illness presents with symmetrical leg and hand weakness, R face weakness, and decreased DTRs in U and L extremities. Sensation is normal. Some autonomic n dysfunction.

A

Guillian-Barré

31
Q

T/F: Guillian-Barré is life-long disability.

A

False - Sx don’t last longer than 4 weeks

32
Q

T/F: Guillian-Barré is treated with immunosuppressive therapy.

A

True (plasma exchange, IVIG) - but not steroids

33
Q

What is the problem in Myasthenia gravis?

A

Reduction in post-synaptic ACh receptors at NMJ (autoimmune)

34
Q

Myasthenia gravis treatment:

A
  1. Suppress immune system (IVIG, prednisone, azathioprine)

2. Increase ACh at synapse (ACEi)

35
Q

Unlike in (myopathy/dystrophy), in (myopathy/dystrophy) there can be degeneration/regeneration of muscle fibers seen.

A

Myopathy; dystrophy

36
Q

Most common adult-onset muscular dystrophy is (X) and, (like/unlike) classic dystrophy, the weakness is primarily (proximal/distal).

A

X = myotonic dystrophy;

Unlike; Distal

37
Q

Myotonic dystrophy is a (focal/systemic) disease.

A

Systemic;

Balding, glucose intolerance, intellectual disability, CV issues, etc.

38
Q

Neuropraxia definition:

A

Mildest form of nerve injury with temporary loss of motor/sensory fxn due to n conduction block (but no degeneration)

39
Q

Focal demyelination of nerve likely causes (neuropraxia/axonotmesis/neurotmesis).

A

Neuropraxia

40
Q

Axonotmesis definition:

A

Nerve injury in which axon is disrupted with little disruption of connective tissue

41
Q

Neurotmesis definition:

A

Most serious form of nerve injury in which both axon and connective tissue (sheath) are disrupted

42
Q

T/F: All nerve injuries require intervention.

A

False - if CT tube intact, none needed (nerve/sheath should grow back); otherwise, re-growth requires ends of tube to be sown together/grafted

43
Q

Cubital tunnel syndrome is injury of (X) at which location?

A

X = ulnar n (compression)

Cubital tunnel (near elbow)

44
Q

Shoulder dystocia will stretch the (upper/lower) part of the brachial plexus.

A

Upper (C5-6) = ERB’S PALSY

45
Q

Upper brachial plexus injury presents with sensory loss primarily to which areas?

A

LATERAL aspect of arm, forearm, and hand

46
Q

Newborn won’t move his L shoulder and arm is in “waiter’s tip” position. This is due to (X). Weakness of which muscles are causing this arm position?

A

X = Erb’s palsy (stretch/injury to C5-6 of brachial plexus)

Lateral rotators of shoulder, arm flexors, hand extensors

47
Q

What’s Klumpke palsy?

A

Injury to lower brachial plexus roots (C8-T1)

48
Q

Little girl comes in because she’d been climbing trees and fell. Aside from some lower extremity bruising, you notice she has “claw hand”, which makes you suspicious for:

A

Klumpke palsy (injury to lower brachial plexus roots)

49
Q

Lower brachial plexus injury presents with sensory loss primarily to which areas?

A

Medial forearm and hand

Neuro DRx (10 decks)

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