12 - neuro

Question 1

Patient has dysarthria, aphasia, vision change, ataxia, and focal weakness. What is the MOST LIKELY cause?

Answer 1

acute ischemic stroke (most common)

Question 2

What is your DDx for ischemic stroke symtpoms?

Answer 2

1) hemorrhagic stroke
2) TIA
3) metabolic derangement
4) atypical migraine
5) mass
6) ischemic stroke

Question 3

What’s the difference b/t TIA and ischemic CVA?

Answer 3

duration

Question 4

What do you order for acute stroke symptoms?

Answer 4

1) CT without!! Order first.
2) CBC
3) BMP (r/o metabolic derangement)
4) glucose
5) coags
6) ESR (for HA, etc)
7) tox screen

Question 5

If patient has ischemic stroke symptoms and is malignantly hypertensive, what is your target BP?

Answer 5

t want to worsen the ischemia)

Question 6

tPA criteria:

Answer 6

1) onset < 4.5 hours
2) INR < 1.7
3) No recent major sx (14 days)
4) No h/o SAH, ever
5) PLT > 100
6) BP < 180/120
7) No MI in last 90 days

Question 7

pt c/o bad headache, neck stiffness, n/v, and AMS. What is this most typical for?

Answer 7

SAH (couldn’t give it away with the thunder)

Question 8

SAH is typically a ruptured ____________ or what congenital problem?

Answer 8

berry aneurysm, or AV malformation

Question 9

SAH work up:

Answer 9

1) CT without

2) LP with xanthochromia if CT is negative

Question 10

Tx of SAH?

Answer 10

1) intubate
2) BP reduction by 20%, then titrate to <140 over next hour
3) sx clip or coil ASAP, even if clotted and not actively bleeding

Question 11

Sudden severe HA with neuro deficits or sz, n/v. What do you suspect?

Answer 11

intracerebral hemorrhage (different from SAH b/c this bleed is more massive and will involve neuro deficits) Presentation similar to ischemic

Question 12

If you see a brain bleed, what do you do?

Answer 12

1) lower BP!
a) aggressively with IV if > 200
b) intermittently with po if > 180
2) Neuro consult

Question 13

1) Convulsive sz lasting longer than _____ minutes
2) Back to back convulsive sz without return to baseline between
3) Recurrent non-convulsive sz…..are the definitions of __________?

Answer 13

5, status epilepticus

Question 14

Tx of status epilepticus:

Answer 14

1) airway
2) r/o hypoglycemia
3) stop the sz!!

Question 15

What medications stop sz?

Answer 15

1) benzo (repeat, repeat Q2min x 3 total)
2) anticonvulsants (to prevent recurrence, PHENYTOIN)
3) conscious sedation (propofol) is last resort, LASTLY general anesthesia.

Question 16

Muscle weakness that improves with rest

Answer 16

myasthenia gravis

Question 17

complication of myasthenia gravis

Answer 17

fatigue of diaphragm leads to respiratory failure, admit to support airway

Question 18

pathophys of myasthenia gravis

Answer 18

Depletion of ACH

Question 19

AI dz that attacks peripheral myelin, characterized by ascending paralysis

Answer 19

guillian-barre (vs MS, which is central myelin)

admit and support airway

Question 20

What is the first sign of guilian-barre?

Answer 20

hyporeflexia

Question 21

Patients with _________ have worse symptoms at night. _________ patients have rapid progression of symptoms

Answer 21

myasthenia, guillian-barre

Question 22

Other than intubation, how are myasthenia and GBS treated?

Answer 22

IVIG, plasmapheresis

Question 23

muscle protein destruction with pain and weakness (proximal) of muscles (often thighs).

Answer 23

rhabdomyolysis

Question 24

causes of rhabdo

Answer 24

1) muscle compression
2) exercise
3) sz–status epi
4) DT’s
5) viral inf
6) drugs (statins)

Question 25

Does rhabdo cause hyper or hypo reflexia?

Answer 25

hypo

Question 26

What labs should be ordered for rhabdo?

Answer 26

CPK elevated
myoglobin in urine
hyperkalemia
BUN/creat

Question 27

tx for rhabdo?

Answer 27

HYDRATION!!