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Current Medical Diagnosis and Treatment 2017 > Ch 24: Nervous System Disorders > Flashcards

Ch 24: Nervous System Disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the essentials of diagnosis for migraine?

A

Headache, usually pulsation, lasting 4 - 72 hours.
Pain is typically, but not always, unilateral.
Nausea, vomiting, photophobia, and phonophobia are common accompaniments.
Pain is aggravated with routine physical activity.
An aura of transient neurologic symptoms (commonly visual) may precede head pain.
Commonly, head pain occurs with no aura.

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2
Q

Ophthalmoplegic migraine is _____ and a diagnosis of _________.

A

rare, exclusion

p. 978

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3
Q

There are 4 categories of pharmacologic prophylaxis of migraine. What are they?

A

Antiepileptics
Cardiovascular drugs
Antidepressants
Other

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4
Q

What population is predominantly affected by cluster headaches?

A

Middle-aged men

p. 979

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5
Q

The term “epilepsy” denotes any disorder characterized by…

A

…recurrent unprovoked seizures.

p. 983

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6
Q

There is no evidence that prophylactic anticonvulsant drug treatment reduces the incidence of _____________ epilepsy.

A

posttraumatic

p. 983

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7
Q

What are the two types of focal seizures?

A

Seizures WITHOUT impairment of consciousness (simple partial) and seizures WITH impairment of consciousness (complex partial).

(p. 984)

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8
Q

What are the key features of a focal seizure?

A

Involvement of only a restricted part of brain; may evolve to a bilateral, convulsive seizure.

(p. 984)

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9
Q

What is the key feature of a generalized seizure?

A

Diffuse involvement of brain at onset.

p. 984

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10
Q

What are the 6 categories of generalized seizures?

A 
absence (petit mal)
atypical absence
myoclonic
tonic
clonic
tonic-clonic (grand mal)

(p. 984)

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11
Q

What are the key features of an absence (petit mal) seizure?

A

consciousness impaired briefly; patient often unaware of the attacks

(p. 984)

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12
Q

What are the other characteristics of an absence (petit mal) seizure?

A

They may have clonic, tonic, or atonic components, autonomic components or accompanying automatisms.
They almost always begin in childhood and frequently cease by age 20.

(p. 984)

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13
Q

What are the key features of an atypical absence seizure?

A

They may be more gradual in onset and termination than a typical absence seizure.

(p. 984)

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14
Q

What are the other characteristics of an atypical absence seizure?

A

There may be more marked changes in tone.

p. 984

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15
Q

What are the key features of a myoclonic seizure?

A

Single or multiple myoclonic jerks.

p. 984

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16
Q

What are the key features of a tonic seizure?

A

bilaterally increased tone and stiffening of limbs with associated loss of consciousness

(p. 984)

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17
Q

What are the key features of a clonic seizure?

A

Bilateral rhythmic jerking with associated loss of consciousness

(p. 984)

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18
Q

What are the key features of a tonic-clonic (grand mal) seizure?

A

Tonic phase: sudden loss of consciousness, with rigidity and arrest of respiration, lasting < 1 minute
Clonic phase: jerking, usually for < 2 - 3 minutes
Flaccid coma: variable duration

May be accompanied by tongue biting, incontinence, or aspiration; commonly followed by postical confusion variable in duration

(p. 984)

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19
Q

What are the key features of an atonic seizure?

A

Sudden loss of tone, very brief (< 2 seconds), and often result in recurrent falls; also known as epileptic drop attacks

(p. 984)

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20
Q

What are the key features of status epilepticus?

A

Repeated seizures without intervening recovery of consciousness; a fixed and enduring epileptic condition lasting > or = to 30 minutes

(p. 984)

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21
Q

The aura that precedes a generalized seizure is itself a part of the seizure, indicating _____ _____ from a restricted part of the brain.

A

focal onset

p. 985

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22
Q

What is the term for seizures that are provoked by flashing lights?

A

photosensitive epilepsy

p. 985

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23
Q

How can a serum prolactin level help to distinguish between a psychogenic nonepileptic seizure (PNES) and a true seizure?

A

elevation of serum prolactin level to at least twice the upper limit of normal can be seen between 10 and 20 minutes after a seizure or syncopal event, but not after a PNES.

(p. 986)

24
Q

Drug therapy for epilepsy is usually continued until there have been no seizures for at least…

A

…2 years.

p. 986

25
Q

Treatment of seizures with more than 2 drugs is almost always unhelpful unless….

A

…the patient is having seizures of different types.

p. 986

26
Q

All antiepileptics are potentially…

A

…teratogenic.

p. 986

27
Q

What is the initial treatment for status epilepticus?

A

Maintenance of airway.
50% dextrose in case hypoglycemia is the cause.
If seizures continue, IV bolus of lorazepam, 4 mg, at a rate of 2 mg/min; repeat this again after 10 minutes if necessary.
An alternative to lorazepam is midazolam IM, or diazepam gel rectally.

(p. 989)

28
Q

Regardless of the response to lorazepam or midazolam, one of what 2 drugs should be given to initiate long-term seizure control?

A

fosphenytoin or phenytoin

p. 989

29
Q

What dose of fosphenytoin should be given?

A

18 - 20 mg [phenytoin equivalents] /kg at a rate of 50 mg/min

(p. 989)

30
Q

If seizures continue after lorazepam and fosphenytoin, what drug(s) is/are given next?

A

phenobarbital, 10 - 20 mg/kg
In addition to or instead, valproate can be given, 25 - 30 mg/kg.

(p. 989)

31
Q

What is the therapeutic serum drug level for valproic acid (Valproate)?

A

50 - 100 mcg/mL

p. 987

32
Q

What is the therapeutic serum drug level for carbamazepine (Tegretol)?

A

4 - 8 mcg/mL

p. 987

33
Q

What is the therapeutic serum drug level for phenytoin (Dilantin)?

A

10 - 20 mcg/mL

p. 987

34
Q

What are the essentials of diagnosis for TIA?

A

Focal neurologic deficit of acute onset.
Clinical deficit resolves completely within 24 hours.
Risk factors for vascular disease often present.

(p. 991)

35
Q

About __% of patients with stroke have a history of TIAs and 5 - 10% of patients with TIAs will have a stroke within __ days.

A

30%; 90

p. 991

36
Q

Hematologic causes of TIA include…

A

…polycythemia, sickle cell disease, hyperviscosity syndromes, and the antiphospholipid antibody syndrome.

(p. 992)

37
Q

The subclavian steal syndrome may lead to…

A

…transient vertebrobasilar ischemia.

p. 992

38
Q

A CT or MRI of the brain is indicated with __ hours of TIA symptom onset.

A

24

p. 992

39
Q

All patients with TIA in whom anticoagulation is not indicated should be treated with ____________ _______ to reduce the frequency of TIAs and the incidence of stroke.

A

antiplatelet therapy

p. 993

40
Q

What is the ABCD2 score used to determine?

A

it is a assessment of TIA/stroke recurrence risk. ABCD2 score of 4 points or more warrants a hospital admission.

41
Q

Use of natalizumab is generally restricted to those in whom….

A

…JC virus antibodies are negative.

p. 1024

42
Q

What drug is FDA-approved to treat fatigue in patients with MS?

A

modafinil (Provigil)

p. 1025

43
Q

What therapy can be done for MS patients with corticosteroid-refractory relapses?

A

plasmapheresis

p. 1024

44
Q

Mitoxantrone can be given once every 3 months, and has a maximum…

A

…lifetime dose of 140 mg/m2.

p. 1024

45
Q

The maximum dose for mitoxantrone is related to its…

A

…risk of causing cardiomyopathy.

46
Q

For myasthenia gravis, anticholinesterase drugs provide symptomatic benefit without…

A

….influencing the course of the disease.

p. 1045

47
Q

The term concussion is often used synonymously with…

A

…mild TBI.

p. 1029

48
Q

Grades of TBI are traditionally defined by the….

A

…Glasgow Coma Scale measured 30 minutes after injury.

p. 1029

49
Q

Mild TBI is indicated by a GCS of…

A

…13 to 15.

p. 1029

50
Q

Moderate TBI is indicated by a GCS of…

A

…9 to 12.

p. 1029

51
Q

Severe TBI is indicated by a GCS of…

A

… < or = to 8.

p. 1029

52
Q

What types of head injuries may present with normal neurologic findings shortly after injury (lucid interval), but then rapidly deteriorate thereafter?

A

epidural and subdural hematoma

p. 1029

53
Q

What are the common acute symptoms of a concussion?

A

headache, nausea, vomiting, confusion/disorientation, dizziness, and imbalance, and possibly a period of amnesia encompassing the traumatic event;
may present with or without loss of consciousness

(p. 1029)

54
Q

What are some signs of a basilar skull fracture?

A

bruising around the eyes (raccoon sign), blood in the external auditory meatus (Battle sign), and leakage of CSF from the ear or nose (CSF can be identified by its glucose or beta-2-transferrin content)

(p. 1029)

55
Q

Current recommendations are that head CT be performed in patients with concussion and any of the following:

A 
GCS score less than 15
focal neurologic deficit
seizure
coagulopathy
age 65 or older 
skull fracture
persistent headache or vomiting
retrograde amnesia exceeding 30 minutes
intoxication
soft tissue injury of the head or neck

(p. 1030)

Current Medical Diagnosis and Treatment 2017 (41 decks)

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