9. Neurology Flashcards
sudden onset ipsilateral hyperacusis (Ear pain) + Complaining of waking up with Unilateral facial paralysis + uable to lift eye brow or forehead
Name/Risk/Nerve/PE/Tx
Name: Bell’s palsy
Risk: HSV
Nerve: CV7 (facial nerve)
PE: unable to wrinkle both side
Tx: Prednison (less than 72 hrs), artificial tear for lacrimation, Acyclovir
hx of DM + numbness tingling at lower extremities
Name/Tx
Name: Diabetic neuropathy
Tx: Gabapentin for pain, DM control
Ascending(leg first -> arm) weakness (usually symmetric) + DTR decreased + breathing difficulty
Name/Pathogen/Dx/Tx/contraindication/Complication
Name: Guillian Barre syndrome
Pathogen: Campylobacter Jejuni
Dx: CSF (protein high/Normal WBC)
Tx: Plasmapheresis, IVIG
- Contraindicated Prednisone
Complication: Repiratory failure
worsened with repetitive movement (worsen throughout the day/better with rest) + eye lid weakness + breathing problem
Name/Risk/PE/Dx/Tx
Name:MG (myasthenia gravis)
Risk: young women/Thymic abnormality
PE: DTR normal, respiratory muscle weakness
Dx
- ACTH receptor antibodies
- edrophonium (tensilon) test
- ICE pack test (10 min on eyelid better)
- Rule out CT or CXR for Thymoma
Tx
- Pyridostigmine (1st)
- IVIG/Plasmapheresis
- Thymectomy
Throughout the day weakness gets better + weight loss
Name/Related/Patho/Dx/Tx
Name: Lambert-Eaton
Related: SCC
Patho: antibodies against presynaptic voltage gated calcium channels prevents ACTH
Dx: electrophysiology
Tx: plasmapheresis (1st), remove tumor
Bilateral tight band like (vise like) HA + No N/V + focal neurologic (photophobia)
Name/MC type HA/Tx/Prophylaxis
Name: Tension HA
MC common type: Tension
Tx: NSAID, acetaminophen
- May be used for TCA, antimigrain med, BB for prophylaxis
Unilateral HA + visusal change
Name/Risk/Type/Aura/caution/Tx/Prophylaxis
Name: Migraine HA
Risk: MC in Women
Type: classic (with aura), Common (without aura)
Aura: scotoma (blind spots), light flash
Caution: always remember focal neurologic problem possible Stroke
Tx: Triptans
- CI: CAD, uncontrolled HTN or MI
Prophylaxis: BB, CCB, TCA, NSAID
Unilateral HA + around eye pain + lacrimation
Name/Risk/Trigger/Tx/Prophylaxis
Name: Cluster HA
Risk: Males (young/middle age)
Trigger: ETOH, Worse at night
Tx: 100% O2, Triptan meds
Prophylaxis: Verapamil
Meningitis Definition/MC/MC important/Less common/Age group
Definition: infection of membranes covering the brain and spinal cord
MC common: Viral
Most important: Bacterial
Less common: TB, Fungal
Age group Bacteria Pathogen
- less than 1 month - GBS, lister
- 1 mo - 18 yrs - N Meningitidis, H flu
- 18yr - 50 yrs - S pneumo
- 50 yr above - S pneumo, listeria
- Farm worker, pregnancy - listeria
Fever/chill + nuchal rigidity (stiff neck) + alter mental status
Name/PE/Dx/Tx/Prevention/Post exposure (alternate)
Name: Baterial meningitis
PE
- Brudzinski - neck flex + knee hip flex
- Kenig - can’t straighten knee when hip flexed
Dx: CT head (1st), LP (definitive)
Tx: Abx + Admiti ICU
- neonate (less than 1 month) - cefo + ampicillin
- 1 mon - 50y - ceftx + vanco
- 50y above - ceftx + ampicillin + vanco
- Dexamethasone - if strep pneumo (prevent hearing loss H flu)
Prevention: Hib, MCV
Post exposure: Cipro 500mg x 1 dose/alternate Rifampin
Encephalitis vs viral meningitis
Define/Etiology/clinical menifestation/dx/tx
Encephalitis
- Define: infection in Parenchyma
- Etio: HSV
- Clinical menifestation: lethargy, AMS, abnormal brain function
- Dx: LP - high WBC, normal glucose
- Tx: supportive care
Viral meningitis
- Define: infection in Meninges
- Etio: Enterovirus (coxackie)
- Clinical emnifestation: HA, fever, Brudzinski & Kernig sign, Normal brain function
- Dx: CSF - High WBC, Normal glucose
- Tx: Supportive care
Bacteria/Viral/Fungal CSF difference
Bacteria
- Opening pressure high, Glucose low, Protein high, PMN (neurtrophil) high
Viral/Encephalitis
- Opening pressure normal, Glocose normal, protein high, WBC high
Fungal
- Opening pressure Normla or high, Glocose low, protein high, WBC high
Hx of sinus infection or ear infection + HA + fever + neurologiccal finding
Name/Tx
Name: Cerebral abscess
Tx: Ceftx + Metronidazole + surgical drainage
Tremor with movement and resolves at rest or drinking ethanol + often shaky voice + normal DTR and tone
Name/Risk/Tx
Name: Essential tremor
Risk: Elderly, MC movement disorder
Tx: Propanolol
hx of father died in early + behavior change + dementia + Choreiform
Name/Patho/Dx/Tx
Name: Huntington’s disease
Patho: autosomal dominant (50% chance to get it if one of parent has it)
Dx: CT scan (caudate/cerebral nucleus atrophy)
Tx: none (die in 30-50), Benzo helpful
Resting tremor + bradykinesia (slow movement) + rigidity (cogwheel) + fixed facial expression
Name/Define/Related/Tx
Name: Parkinson disease
Define: dopamin depletion
Related
- lewybodies(misfolded protein - accumulation cause death)
- loss of pigment cell seen in the substaintia nigra (contain lots of dopamin makes color - loss cell make depigment)
Tx: Levodopa/carbidopa
Acutely Confused
Name/Risk/Tx
Name: Delirium
Risk: Dementia predisposition
Tx: Underlying cause (Lorazepam)
Children with verbal tics (repeat phrase, throat clearing) or motor tics (blinking, shrugging, head thrusting, sniffling)
Name/Tx
Name: Tourette syndrome
Tx: habit reversal therapy (pimozide)
Decline of memory overtime + elderly
Name/Related/Worsen comobid/Dx/Tx/Other dementia (4 type)
Name: Dementia
Related: MC alzheimer, vascular demntia(2nd)
Worsening: UTI, TSH
Dx: CT scan
Tx: Alzheimer - Donapezil, Vascular - ASA
Other dementia type
- Alzheimer (1st)
- Vescular (2nd) - launar infarcts
- Frontotemporal dementia - localized brain degen (personality chang)
- Lewybody - visual hallucination
Uni eye pain + loss of color vision + babinski test upwards
Name/Patho/MC subtype/Risk/Dx/Tx
Name: MS (mutiple sclerosis)
Patho: autoimmune, inflammatory demyelinating disease
MC subtype: relapsing-remitting
Risk: 20-40 female
Dx: MRI - periventricle view shows white matter plaque, LP - IgG (oligoclonal bands) in CSF
Tx: Acute - IV corticosteriod, Plasmapheresis
- relapsing-remitting - B- interferon
Seizure classification 3 major with subtype explain
- Partial (focal) seizure - hemisphere brain effect
- Simple - remembers + sensory strange (taste problem) + jerking
- Complex - doen’t remember + Automatisms (lip smacking, manual picking, patting)
- General seizure - both hemisphere brain effect
- Absense (petit mal) - childhood, brief staring eye twitching, loss and gain conciouseness (brief)
- Tonic clonic - rigidity, jerking fall backword, LOSS CONCIOUSNESS
- Myoclonic - short muscle twiching
- Atonic - relaxed fall forward (loss of posture tone)
- Status epilepticus - repeated gen seizure without recovery
EEG shows 3 HZ spike wave
Name/Risk/Presents/Dx/Tx
Name: Absence seizure
Risk: young child (stop after 20)
Presents: Relaps of conciousness (lose and gain) + staring, eyelid twitching
Dx: EEG
Tx: Ethosuximide
Treatment of seizures
Partial seizure - carbamazepine
General
- absence - ethosuximide
- grand mal, myclonic - vaproic acid
- Epilepticus - lorazepam, diazepam -> phenytoin -> phenobarbital
Mixed upper and lower motor neron signs + sensation, urinary spincter, voluntary eye movement are spared
Name/Tx
Name: ALS (amyothrophic lateral sclerosis)
Tx: Riluzole (reduce progressive upto 6month) fatal in 3-5 years
burning sensation at leg + Worse at night + improve with movement
Name/Tx
Name: Restless legs syndrome
Tx: dopamin agonists (pramipexole,Ropinirole)
- Iron supplement (check ferritins level lower than 75)
hx of birth defect (limb-length discrepancies) + intellectual/learning disabilities
Name/PE/Tx
Name: Cereberal palsy
PE: hyperreflexia
Tx: multidisciplinary approach, improve spasticity - diazepam
facial burning, pain with wind blowing, touch, eating
Name/Tx
Name: TGN (trigeminal neuralgia)
Tx: carbamazepine
HA + visual change + papilledema + CT scan no mass found
Name/Dx/Tx
Name: idiopathic intracranial HTN
Dx: CT(1st) -> LP - increased pressure with normal glucose
Tx: acetazolamide
Dementia + gait disturbance + urinary incontience + MRI large venticle + No abnormal CSF
Name/define/Tx
Name: Normal pressure hydrocephalus
Define: dilation of the cerebral without abnormal CSF
Tx: Ventriculoperitoneal shunt
Sport activities with loss of conciouse + confusion + amnesia
Name/Dx/Tx
Name: Concussion syndrome
Dx: CT (1st for acute), MRI for 7-14 days event/worsening sx
Tx: Cognitive & physical activities rest
- if sx resolved they can resume activities - if more than 3 consecutive concussion must stop activities for whole season
Vertical compression accident vs hyperextension of the skull accident
Name/Dx/Tx
- Vertical compression - C1 fx (jefferson)
- Dx: Lateral X-ray (open mouth view)
- Tx: non op - collar x 6-12 wks
- hyperextend - C2 fx hangman
- Dx: CT scan
- Tx
- less than 3mm displace collar 4-6week
- 3-5mm displace close reduction
- more then 5mm displace OP
hx of atherosclerosis + BP difference between arms
Name/Dx/Tx
Name: subclavian steal syndrome
Dx: CT angio
Tx: revascularization
Spinal cord injury
Mechanism of injury/deficit
- Anterior cord
- Mechanism of injury: direct compression (blow out vertebral body burst)
- Deficit - lower > upper (bladder dysfunction)
- Central cord
- Mechanism of injury: Incomplete cord syndrome, hyperextension MVA
- Deficit: upper > lower (shawl distribution)
- Posterior cord
- Mechanism of injury: rare
- Deficit: loss of proprioception & vibratory sense only (normal temperature and no pain)
- Brown sequard
- Mechanism of injury: stabbing trauma (unilateral damage)
- Deficit
- Ipsilateral - motor, vibration & proprioception problem
- contralateral - pain & loss of temp
Brain damage left vs right side, broca vs wernicke
- Left - dominant (speech language) right side weakness, sensory
- right - nondominant (flat affect, impaired judgment), left side weakness, sensory
- Broca apasia - difficulty speaking with comprehension ability
- Wernicke apasia - difficulty speaking with no comprehension ability
sudden weakness of extremity + amaurosis fugax (monoocular vision loss) + recovers after couple hours(less than 24 hrs)
Name/Risk/PE/Dx/Tx/Contraindication
Name: TIA (transient ichemic attack)
Risk: DM, HTN, aFib
PE: Amaurosis fugax
Dx: CT scan
Tx: ASA + clopidogrel
- Thrombolytic contraindicated
Stroke location
- MC stroke location?
- Face and arm
- Leg and foot + face spared
- crossed sx (visual hallucination)
- Stroke Dx?
- Stroke Tx?
- lacunar infarct
- middle cerebral artery
- anterior cerebral artery
- Posterior cerebral artery
- CT noncontrast
- Thrombolytic in 3 hours (alteplase) CI: 185/110 or any recent bleeding
temporal bone fx + convex on CT
Name/location/Dx/Tx
Name: Epidural hematoma
Location: arterial bleed (between skull and dura)
Dx: CT (convex, do not cross suture line)
Tx: small observe, ICP high - mannitol
blunt trauma + Concave on CT
Name/location/Dx/Tx
Name: subdural hematoma
Location: venous bleed (bridge vein)
Dx: CT concave (cross suture line)
Tx: Supportive
Thunderclap + worst HA of my life
Name/Dx/Tx
Name: SAH (subarachnoid hemorrhage)
Dx: CT first none then DO, LP (high open pressure + RBC or xanthocromia), Confirm by 4 vessel angiography
Tx: Nicardipine, nimodipine (gradual BP drop)
hx of HTN + HA, N/V + CT shows bleeding
Name/Dx/Tx
Name: ICH (intracerebral hemorrhage)
Dx: CT (intraparenchymal bleed), DO NOT perform LP (may cause herniation)
Tx: Supportive (ICP high - mannitol)
Sensitive touch (cold) + Burning thrombing pain and swelling at extremities (arm & leg) + hx of stroke, injuries site (4-6weeks ago)
Name/History/Tx/Prevention
Name: Complex regional pain syndrome
History: 4-6 weeks after fx or surgery
Tx: PT (1st) + NSAID, gabepentin
Prevention post fx: vitamin C helpful to prevent
Recurrent HA in children + seizure + intracranial hemorrhage in image
Name/Patho/Dx/Tx
Name: AV malformation
Patho: Artery to vein transfer without passing capillary system
Dx: MRI(initial), X-ray angiography (gold)
Tx: Neurosurgery referral
Mad cow disease caused by what?
Prion
EPS 4 type sx and tx
Typical > atypical antipsychotics
Acute dystonia: muscle spasms, stiffness, oculogyric crisis, tx: benztropine, dyphenhydramine
Akathisia: restlessness, tx: benztropine
Bradykinesia: Parkinsonism, tx: benztropine
Tardive dyskinesia:orofacial involuntary movements, Tx: Stop offending agent
