aan Flashcards
Cardinal Signs of Parkinson’s
Postural instability
Resting Tremor
Cogwheel rigidity
Bradykinesia
CSF findings in MS
Mild Pleocytosis w/ low PMN’s
NL glucose
NL to mildly elevated proteins
ie WBC 20, PMN 5%, Glucose 75, Protein 80
ie CSF study mostly normal, look for IgG oligoclonal bands
What is the recommendation for a person that encounters a concussion through a contact sport?
D/c play for today, evaluate prior to the next game
Must be asymptomatic at rest w/o medication
Pt is able to draw geometric shapes, but cannot draw specific animals and all attempts at drawing an animal look the same
Semantic Problem - lost the sense of what makes animals unique. Defect in dominant lateral temporal lobe. Associate with Alzheimer’s
Being able to draw shapes suggest corticospatial is intact (non dominant parietal lobe)
What is a good medication for a female of child bearing age with a generalized seizure disorder
Lamotrigine - just titrate up slowly to avoid Stevens Johnson
Avoid valproic acid and phenytoin - birth defects
Topiramate is a good choice but may have cognitive side effects
Pt has syx similar to migraine, but is not responsive during episodes and is fatigued after. She has no memory of the event
Give lamotrigine - effective in simple and complex seizures
These AOC are suggestive of temporal lobe epilepsy
Syx of ICA dissection
Horner syndrome (ipsi ptosis, anoscoria) + Contra hemiparesis (varying levels) Stroke like syx in a younger pt following a trauma, or can be seen in elderly
Pt has loss of L superior corner of visual field in both eyes. Where is the lesion?
R temporal
“pie in the sky” visual loss indicated lesion w/in the Meyer loop of the temporal lobe
DM pt with neuropathy is highly suggestive of also having?
nephropathy OR retinopathy - if they have neither the cause may not be related to their DM
Symmetric sensory neuropathy
3 cardinal findings in brain death
- Unresponsiveness
- Absence of Brainstem reflexes
- Apnea
Glove and stocking parathesia + Proximal and distal muscle weakness x nmonths
+ slowed nerve conduction velocity + elevated protein in CSF
Chronic inflammatory Demyelinating polyneuropathy (CIDP)
Chronic form of Guillain-Barre. Can look similar but months vs weeks
Compare Becker and Duchenne muscular dystrophy
Both are X-linked
BMD progresses at a much slower late, so suspect DMD in a young pt
What syx is expected in a small fiber peripheral neuropathy?
Loss of temperature sensation
Pain and temperature are perceived through the small fibers (hence burning pain and parathesia)
Debilitating HA triggered by weather changes
Migraine w/o aura
Pt has defect in facial recognition. Where is the lesion?
Prosopagnosia
b/l inferior occipitotemporal cortex (fulsiform gyrus
Conductive aphasia + R homonymous hemianopsia + vomitting
Intracerebral hemorrhage of the L temporal and parietal lobe
Middle aged man has night terros and vivid dreams
REM sleep behavior disorder (RBD)
Associated with onset of neurodegenerative disorders (approx 10 years later); Parkinson’s, Lewy Body
Loss of motor atonia during sleep causing pts to act out their dreams
Expressive aphasia (lack of fluency, intact comprehension, intact awareness)
Dominant frontal cortex
Dementia pt has bradycardia, be suspicious for which med?
Donepezil
cholinesterase inhibitor
IDD w/ long narrow face, prominent ears, large body habitus, low muscle tone, macroorchidism
Fragile X syndrome
mutation in FMR1
Medical management of ischemic stroke
tPA w/in 4 hours of syx onset (if BP <185/110)
ASA 24 hours later
Heparin for long term
Pt has neck pain and Horner syndrome after a chiropracter appointment. What study does she need?
MRA
Look for Carotid or vetebral dissection
Which MS treatment is associated with increased risk of depression
IF Beta
Pt has general weakness the morning after working out and a large dinner
Check Sr K+
Hyper or Hypokalemic periodic paralysis
AD, K+ can be normal between attacks
