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Block 3: Neuro > Clin Med: Neuro I > Flashcards

Clin Med: Neuro I Flashcards

1
Q

3 “headache” populations

A
  • Outpt office- usually migraine or tension
  • ER–> must immediately exclude life threatening headaches
  • Headaches during pregnancy
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2
Q

To differentiate a HA from brain bleed use…

A

RED FLAG SYMPTOMS

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3
Q

SSNOOP criteria to ID red flag symptoms

A
  • Systemic symptoms
  • 2ndary risk factors/underlying dz (HIV, cancer)
  • Neurologic signs/symptoms (confusion, focal neuro findings)
  • Onset (sudden, abrupt)
  • Older age (new onset/progressive)
  • Pattern change (change from previous is frequency or severity)
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4
Q

Primary HA examples

A
  • Migraine
  • Tension
  • Cluster
  • Other (cough, exercise, post coital)
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5
Q

2ndary HA examples

A
  • Trauma
  • Vascular (TIA, CVA)
  • Substance or substance withdrawal
  • Infx (meningitis, influenzas)
  • Disorder of homeostasis (HTN, altitude, sleep apnea/hypoxia)
  • Attributed to disorder of eyes, ears, sinuses, teeth
  • Psychiatric Disorder
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6
Q

Painful Cranial Neuropathies/Facial Pain Examples

A
  • Trigeminal neuralgia
  • Optic neuritis
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7
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8
Q

What is considered an episodic tension HA?

A

14 or less per month

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59
Q

Cluster HA Dx

A
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60
Q

abortive therapy for cluster HA

A
  • First line–> 100% O2 high-flow mask w/ pt in sitting position
    –> 10-20 minutes
  • triptans
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61
Q

Prophylactic therapy for cluster HA

A
  • Verapamil
  • Lithium
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62
Q

“Other” Tx for Cluster HA

A
  • Suboccipital corticosteroid injections in the greater occipital nerve
  • Prednisone for 5 days post-attack
  • Galcanezumab (Emgality)
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63
Q

Describe a cough induced HA

A

usually only lasts a few mins after coughing. Last just a few secs or mins

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64
Q

Describe an exercise - induced HA

A

can last up to a few hrs after strenuous exercise

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65
Q

Describe a post-coital HA

A

A sudden, severe, throbbing HA that occurs just before or at the moment of orgasm

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66
Q

Define Multiple Sclerosis

A

Demyelinating disease of the CNS

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67
Q

What age group has relapsing & remitting MS?

A

25-29yo

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68
Q

What age group has primary progressive MS?

A

39-41yo

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69
Q

MS is more common in which gender?

A

women

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70
Q

MS risk factors

A
  • Low UV light exposure (living in northern latitudes, ?Vit D)
  • Smoking
  • Obesity
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71
Q

MS pathophys

A

demyelination occurs when the immune system inappropriately causes B & T cells to attack & destroys myelin, causing inflammation which leads to more immune response & more inflammation

72
Q

MS S/S:Hx

A
  • Optic neuritis
  • limb weakness
  • numbness, feelings of pins & needles
  • urination or BM problems
  • vision problems - impaired vision, pain w/ eye movements, double vision, or jerking sensation in visual field
  • gait impairment
73
Q

MS PE: focal spinal cord inflammation

A
  • any form of paresis
  • flaccid muscle tone
  • reduced/abnl sensation
74
Q

MS PE: oculomotor exam

A
  • disconjugate eye movements
  • nystagmus
75
Q

MS PE: brainstem, cerebellum, or cerebral dysfunction

A
  • dysmetria on finger-to-nose testing
  • intentional or postural tremor
  • facial paresis or hypoesthesia
  • dysarthria
  • dysphagia
  • cognitive impairment
76
Q

What features are suggestive of MS?

A
  • relapses & remissions
  • onset b/t 15-50yo
  • optic neuritis
  • Lhermitte sign
  • Internuclear ophthalmoplegia
  • fatigue
  • heat sensitivity (Uhthoff phenom)
77
Q

MS diagnosis requires

A

involvement of ≥ 2 areas of CNS (dissemination in space) at different time points (dissemination in time)

78
Q

MS Dx Labs

A
  • CBC
  • ESR/CRP
  • LFT
  • BUN/Cr
  • Ca++
  • glucose
  • thyroid function
  • vit B12 deficiency,
  • HIV
79
Q

What will MRI show for MS?

A

lesions

80
Q

What will CSF analysis show for MS?

A

oligoclonal bands (IgG)

81
Q

MS acute episode, including relapse Tx

A
  • dexamethasone
  • methylprednisolone
82
Q

MS 1st line tx for relapse prevention

A
  • Glatiramer acetate (Copaxone)
  • Interferon B-1b (Betaseron)
83
Q

Define Myasthenia Gravis

A

An autoimmune disorder affecting the NMJ

84
Q

How will a patient present w/ Myasthenia Gravis?

A

painless, fluctuating weakness of muscle groups & often begins w/ ocular s/s (ptosis & diplopia).

85
Q

Myasthenia Gravis: gender prevalence

A

< 50yo, 3x more common in females

> 50yo, initial dx slightly more males

86
Q

Myasthenia Gravis is assoc. w/ what other autoimmune disorders?

A
  • Thyroiditis
  • SLE
  • RA
87
Q

What can occur in 15% of pts with Myasthenia Gravis?

A

Thymoma

88
Q

Myasthenia Gravis pathophys

A

Autoimmune so, body thinks something is wrong w/ the ACh receptors–> body creates autoantibodies that block the ACh receptors–> ACh can’t bind–> causes muscle weakness

89
Q

Myasthenia Gravis: S/S&Hx

A
  • ocular weakness asymmetric ptosis & diplopia
  • Dysarthria (difficulty speaking)
  • change in voice
  • trouble chewing
  • dysphagia
  • weakness & fatigue progress throughout day & worsen w/ activity
90
Q

Myasthenia Gravis: PE

A
  • check for muscle weakness & fatigability
  • impaired eye muscles (extraocular muscles) [painless asymmetries]
  • Orbicularis oculi weakness, ectropion, or “peek” sign
  • cranial nerve examination
91
Q

Myasthenia Gravis: neuro exam findings

A
  • asymmetry pattern of weakness of extraocular muscles not involving the same nerve
  • normal pupil function
  • try to elicit ptosis
92
Q

Myasthenia Gravis: Dx

A
  • Acetylcholine receptor (AChR), muscle-specific tyrosine kinase (MuSK), or lipoprotein receptor-related protein 4 (LRP4) antibodies
  • EMG–> nerve will eventually fatigue & not respond to stimuli
  • edrophonium chloride (Tensilon) test resulting in unequivocal resolution of weakness
  • CT chest–> thymus tumor?
93
Q

Acetylcholinesterase inhibitors
- Pyridostigmine
- Neostigmine

A

Acetylcholinesterase inhibitors
- Pyridostigmine
- Neostigmine

94
Q

How do Acetylcholinesterase inhibitors work?

A

Prevent the breakdown of Ach in the NMJ–> incr chance of ACh getting on receptors that aren’t blocked

95
Q

In Myasthenia Gravis ___ can be given w/ exacerbations & severe dz?

A

Immunoglobulins

96
Q

What tx meds can lessen autoimmune rxn in Myasthenia Gravis?

A
  • Corticosteroids
  • IVIG
  • plasma exchange
97
Q

Myasthenia Gravis requires what tx?

A

intubation & ICU admit

98
Q

In Myasthenia Gravis, __% of people will have ____ w/n ____ of ill

A
  • 25%
  • resp failure
  • first year
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Q

Define Delirium

A
  • caused by acute illness or drug toxicity (sometimes life threatening) - often reversible
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106
Q

I WATCH DEATH mnemonic

A

I - Infx (UTI, pneumonia, encephalitis)

W - Withdrawal (ETOL, benzos, sedative-hypnotics
A - Acute metabolic (ETOL
T - Toxins (opioids, steriods, anticholinergics, psychotropics)
C -
H

D - Deficiencies (thiamine w/ ETOL, B12)
E - Endocrine (thyroid, hypo/hyperglycemia, adrenal insuff)
A - Acute vascular (shot, HTN enceph)
T - Trauma
H - Heavy Metals

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Q

What is the most common form of dementia?

A

Alzheimer’s Dz

116
Q

Define Dementia

A

acquired deterioration in cognitive abilities resulting in decrease in ADLs

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143
Q

Dementia (all forms) Non-pharm approaches

A
  • structure and routine
  • no nonessential drugs
  • Exclude unrecognized delirium, pain, urinary obstruction, or fecal impaction
  • Caregivers speak simply to the patient, break down activities into simple component tasks
  • Aerobic exercise (45 mins most days/week) & frequent mental stimulation
144
Q

Alz (Dementia) Pharmacologic Tx

A
  • Cholinesterase inhibitors for functional impairment
  • NMDA receptor antagonist for cognitive ability
145
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Alz Vascular (Dementia) Tx

A
  • Control RFs for stroke
  • Cholinesterase inhibitors for functional impairment
  • NMDA receptor antagonist for cognitive ability
146
Q

Dementia w/ Lewy Bodies Pharmacologic Tx

A
  • Cholinesterase inhibitors
  • Antipsychotics for behavior changes
  • Benzos for sleep disorders
147
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Frontotemporal Dementia Tx

A

Antipsychotics for behavior changes

Block 3: Neuro (10 decks)

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