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WHOLE PT > CNS > Flashcards

CNS Flashcards

1
Q

A fib can lead to..? What is cx called?

A

stroke

emoblic stroke

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2
Q

Pt has HA + slurring speech + facial droop? What lab to order?

A

cerebral ischemic stroke
lab: CT ASAP
+/- syphillis

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3
Q

What is the timeline for TPA in ischemic stroke?

A

4.5hrs

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4
Q

How to tx ischemic stroke if after 4.5hrs?

A

ASA

clopidigrel

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5
Q

Pt has curtain like blindness 30min ago but now it’s ok? What was that sx called?

A

transient ischemic attack

Amaurosis fugax

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6
Q

How to tx transient ischemic attack? What to be worried about?

A

ASA

pt has high risk of stroke in couple months

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7
Q

Pt has dsyarthria and clumsy hand? What is cx and how to tx?

A

lacunar stroke-internal capsule

cx: thrombosis
tx: self limiting

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8
Q

Pt is oddly looking at your from his right side and has difficulty talking? What is the sx called? What other sx to expect? How to tx?

A

posterior cerebral artery
sx: ipsilateral gaze, contralateral hemiplegia
other sx: dysarthria, aphasia
tx: ASA

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9
Q

Pt has dysarthria-ddx?

A

lacunar stroke and middle cerebral artery stroke

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10
Q

Pt has posterior cerebral artery - what to expect on eye exam?

A

3rd nerve palsy- eye is dilated and not reactive to light; eye is out and downward; lid is closed

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11
Q

Pt has blindness, altered mental status? Tx?

A

distal posterior cerebral artery

tx: ASA

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12
Q

What strokes are tx’d with ASA?

A

ischemic stroke that is over 4.5hrs
TIA
posterior cerebral artery
distal posterior cerebral artery

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13
Q

What is a RF for BOTH ischemic and hemorrhagic stroke?

A

HTN

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14
Q

What are the main sx for hemorrhagic stroke? What are main tx?

A

signs of increased intracranial pressure- HA, vomiting, papilledema
tx: reduce HTN, mannitol, diuretics

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15
Q

Pt has pin point pupils?

A

intracerebral hemorrhage - pons

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16
Q

Pt has poorly reactive pupils?

A

intracerebral hemorrhage - thalamus

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17
Q

Pt has dilated pupils?

A

intracerebral hemorrhage- putamen

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18
Q

What is the main cause for a hemorrhage stroke in adults? young adults?

A

adults: age

young adults: cocaine

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19
Q

Where is the most common area for cerebral hemorrhage? PE?

A

putamen

PE:dilated pupils

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20
Q

Pt has sensory defect + phasia + visual defect?

A

thalamic

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21
Q

Pt has decerebrate + dolls eyes?

A

pin point

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22
Q

Pt has occipital HA + gait ataxia?

A

cerebellar

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23
Q

Pt has focal HA + vomiting?

A

lobar

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24
Q

How do you expect pt to describe “worst HA of my life”? Gold standard? Tx?

A

subarachnoid hemorrhage
angio is gold standard
surgical clipping/endovascular coil

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25
Q

Pt brings in baby by intermittent explosive disorder mother - what to expect in eye of baby? What to expect on CT?

A

acute subdural hematoma
blow pupil
CT: CRESCENT shape

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26
Q

How to tx acute subdural hematoma?

A

burr hole drainage

craniotomy

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27
Q

Pt lives alone and daughter says grandma isnt acting the same; more forgetful and drowsy - how to tx?

A

chronic subdural hematoma

tx: watchful waiting

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28
Q

Pt was skateboarding and hit his head (not wearing a helmet); brought in by friends and says he lost conscious but now he’s back- what to expect on PE? What is best next step?

A

epidural hemorrhage
PE: fixed, dilated pupil
next step: CT and find ROUND hematoma (b/c it is near the sutures and cannot pass it unlike subdural is under sutures and spreads)

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29
Q

What phases to epidural hemorrhage pts go under?

A

unconscious -> lucid interval -> coma

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30
Q

How to tx epidural hemorrhage?

A

surgery and control bleeding

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31
Q

What is the pathophys behind epidural hemorrhage?

A

laceration of middle meningeal artery + skull fx

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32
Q

Pt comes home from school and complains of pulsating noise in head? What imaging study? How to tx?

A

av malformation
MRI >CT
tx: surgery, embolization, stereotactic radiation

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33
Q

Which pts are at risk for moyamoya dz and what to expect on imaging?

A

japanese, native americans

puff of smoke

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34
Q

What is the pathophys of moyamoya dz?

A

small stenosis occurs forcing new collateral circulation in brain

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35
Q

What are sx of ICP?

A 
HA
seizures
vomiting
papilledema
cushing triad
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36
Q

What is cushing triad?

A

increasing BP
falling pulse
widening pulse pressure

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37
Q

What are sx of parkinsons?

A 
pill rolling tremor
mask like face
shuffling gait
trouble initiating first step
lack fo arm swinging w/arm 
later: behavioral changes, dementia
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38
Q

What dementia is related with parkinson?

A

lewy body

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39
Q

What is the pathophys behind parkinsons?

A

death of the cells in substantial nigra of the basal ganglia

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40
Q

What are PE you have pt do to help dx parkinsons?

A

rigitidy/cogwheel

bradykinesis

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41
Q

How to tx parkinsons-first line? What does this drug target?

A

benztropine

target: tremors

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42
Q

What drug should be used as last resort for parkinsons?

A

leveodopa/carbidopa

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43
Q

Pt just graduated from college and got a new job but having complaints of attitude problems at work and having trouble walking? What to watch out for in this pt?

A

huntington

pt have high risk of suicide-counseling is needed

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44
Q

What type of motor/movement skills prob does Huntington have?

A

chorea

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45
Q

What is the pathophys behind Huntingont’s?

A

loss of GABA producing neurons

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46
Q

Pt has trouble eating with chopsticks - type of tremor? What makes it better?

A

essential tremor

better: ETOH

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47
Q

Pt has trouble writing name? Is this bilateral or unilateral? tx?

A

essential tremor
bilateral
tx: propranolol

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48
Q

What kind of genetic dz is Huntington?

A

autosomal dominant

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49
Q

What drugs may cause parkinson?

A

neuroleptic drugs - haloperidol (tourette)

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50
Q

What is the timeline for tourette?

A 
5yo - blinking
7yo - snorting, shrugging
14yo - head shakes, phonetic
19yo - subtle head shake + abdominal tensing
*gets better w/age
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51
Q

What is tourette associated with?

A

OCD

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52
Q

How to tx tourette?

A

haloperidol

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53
Q

Pt’s wife says that husband keeps kicking her in bed and husband is feeling fatigue? What to find on PE? What is best next step?

A

restless leg syndrome
PE: NORMAL neuro exam
next step: check serum ferritin (would be low) for anemia

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54
Q

What is criteria for restless leg syndrome?

A

urge to move legs
worse at night
creepy-crawling sensation that improve w/ movement

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55
Q

Tx for restless leg sx?

A

lifestyle changes

dopamimetics, gabapentin

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56
Q

Pt has bipolar dz that has been improving and now has smacking lips probs? Cx? Tx?

A

tardive dyskinesia
taking dopaminergic antagonist
remove drug

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57
Q

What is a strong correlation with dementia?

A

anticholinergics

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58
Q

What are some drugs for dementia?

A

donepezil - cholinesterase inhibitor

memantine - neuropeptide modifier/glutamine blocker

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59
Q

What are ddx of dementia?

  • primary neurologic disorders?
  • infwn?
  • metabolic?
  • drugs?
  • mood?
A
  • tumor
  • HIV/neurosyphilis; Creutzfeldt jakob
  • thyroid dz; vita B12 def; thiamine def
  • alcoholism
  • pseudodementia (depression)
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60
Q

Pt has HTN + atherosclerosis - highest risk for which dementia?

A

binswanger dz

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61
Q

Pt has vascular dementia- what to expect on PE?

A

hemiparesis
unilaterla babinski
visual field defect

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62
Q

Pt has B1 def? Seen in who? Reversible?

A

wenicke
alcoholics
reversible w/thiamine

63
Q

Pt has CHRONIC vB1 def? Seen in who? Reversible?

A

korsakoff sx
alcoholics
NOT reversible

64
Q

What type of dz is Creutzfeld-Jakob? PE?

A

prior dz

rapid progressive demenia

65
Q

Pt has hallucination? What is this associated with?

A

Lewy body

parkinson

66
Q

What are cxs of delirium?

A 
P. DIMM WIT
P-ostoperative state
D-ehydration
I-nfxn
M-eds
M-etals
W-ithdrawal
I-inflammation
T-rauma
67
Q

What is delirium?

A

ACUTE period of cognitive dysfxn

68
Q

Pt is in high school and is in dancing club but starting to feel numbness in toes and having trouble with bladder? What other sx would pt have? What PE would be positive?

A

multiple sclerosis
Uhthoff - worse sx when in hot temp
sx - vision changes: optic neuritis, tremors, fatigue
Lhermitte - when pt head is flexed there is electrical sensation that runs down back into limb

69
Q

What labs to run for MS?

A

CT to check for plaques in lateral ventricles

oligoclonal banding; more proteins

70
Q

What is MS?

A

autoimmune that results in demyleination of axon

71
Q

What are the different phases of MS? What is each defined?

A

relapsing remitting- episodic, never return to baseline, worse sx w/ every episode
secondary progressive - starts off as relapsing but turns into primary progressive (never getting better/not episodic)
primary progressive - not episodic - always getting worse
progressive relapsing -episodic and progressively getting worse

72
Q

What is NOT typical for MS?

A 
50 yo
cortical deficits (alexia, agraphia, apraxia, aphasia)
seizures
early dementia
rigidity (basal ganglia)
73
Q

How to tx MS?

A 
nothing - DMT (Dz modifying therapy)
-does not reverse sx, resuce acute MS relapses, slow dz
acute? - HD, short corticosteroids; plasma exchange
Beta interferons (pallative) 
Vita D (doesn't hurt to give em; may reduce relapse if it works)
OT/PT (to make them more functional)
74
Q

Pt had pneumonia and now has weakness in legs and arms? What to expect on PE? What sx can this dz lead to? What labs?

A

guillain barre sx
generalized paralysis - resp arrest
PE: DTRs are GONE
CSF: high protein after 14days but normal ct

75
Q

What is guillain barre? CLASSIC sx?

A

autoimmune demylinating poly neuroapthy

ASCENDING weakness/paralysis - rubbery legs

76
Q

What is MAIN cx of guillian barre (bug)?

A

campylobacter jejuni

77
Q

How to tx guillian barre?

A

+/- vent support

plasmapheresis IVIG

78
Q

Pt says that eyes are extremely tired by the end of the day and cannot keep them open? What vision prob will they complain of?

A

myasthenia gravis
ptosis
diplopia
blurred vision

79
Q

What is the pathophys behind myasthenia gravis and who do you see this in?

A

autoimmune dz

women; 20-3yo

80
Q

What is a medical emergency found in pts with myasthenia gravis?

A

diaphragm and intercostal fatigue (muscles that are used ALL THE TIME) - respiratory prob

81
Q

What must be r/o in myasthenia gravis? How can it be r/o?

A

thymoma

CT

82
Q

Are the DTRs preserved in myasthenia gravis?

A

yes

83
Q

Myasthenia gravis tx?

A

long acting anticholiesterase

immunosuppresion

84
Q

How to differentiate between myasthenia gravis and lambert eaton myasthenic syndrome?

A

LEMS has DEPRESSED/ABSENT reflexes

85
Q

Child has progressive SYMMETRIC muscle weakness? PE?

A

Duchenne’s muscle dystrophy
PE: 1) gower’s - not able to get up without using hands
2) calfs are big then weak

86
Q

How to dx duchenne’s muscle dystrophy?

A

muscle bx

87
Q

Tx for duchenne’s muscle dystrophy?

A

prednisone

88
Q

What is duchenne’s muscle dystrophy?

A

X linked

89
Q

What is becker’s muscle dystrophy?

A

like duchenne but less severe and later onset

BOTH: x linked

90
Q

What is lambert eaton myasthenic syndrome usually associated with?

A

small cell lung carcinoma

91
Q

Pt has cafe au lait spots and rubbery cutaneous tumors? How to dx?

A

neurofibromatosis

bx

92
Q

What are the autosomal dominant neurocutaneous syndromes?

A

neurofibromatosis

tuberous sclerosis

93
Q

Pt has cutaenous lesions, brain tumors, mental retardation and is dx by CT?

A

tuberous sclerosis

94
Q

Pt says “theres a pebble stuck in my shoe”? Where does it occur?

A

morton’s neuroma

metatarsal head @ 3rd and 4th toe

95
Q

How to dx morton neuroma and tx?

A

dx: MRI
tx: change shoe, CS, excise

96
Q

Pt has Brown sequard syndrome - what is lost on contralateral and ipsilateral side? What are teh tracts?

A

pain and temp on CONTRALATERAL - spinoathalamic

position and vibration - dorsal column

97
Q

What is associated with pancoast tumor? What are PE?

A

horner’s syndrome

PE: ipsilateral ptosis, miosis, anhidrosis

98
Q

What are the 2 types of vertigo?

A

benign positional vertigo

meniere dz

99
Q

What is the triad of menieres dz?

A

vertigo
tinnitus
hearing loss

100
Q

What is PE of BPV?

A

only CERTAIN positions trigger veritgo

101
Q

How to tx BPV?

A

meclizine

102
Q

Pt has fears of needles and passes out?

A

neurally mediated vasovagal

103
Q

Pt was defecating and passes out?

A

neurally mediated situational reflex

104
Q

What are PE that BOTH vasovagal and situational reflex neurally mediated syncope have? How to tx?

A

prodromal phase

  • diaphoretic
  • pallor
  • palpitation
    tx: supportive
105
Q

What is the prob with neurally mediated vasovagal?

A

ANS is going out of control

INCREASE of parasympathetic

106
Q

What is the difference between volume depleted and neurogenic orhtostatic syncope?

A

volume depleted has decrease w/in 15sec + COMPENSATORY HR

neurogenic orthostatic syncope has decrease of 20systolic and 10diastolic in 3min + NO compensatory HR

107
Q

What are primary and secondary cxs of neurogenic orthostatic syncope?

A

primary - parkinsons, alzheimer

secondary - DM, amyloidosis

108
Q

Dx neurogenic orthostatic syncope?

A

tilt table testing

109
Q

How to tx orthostatic syncope?

A

pseudoephederine
caffeine
NSAID
BRING UP BP

110
Q

What are 2 causes of cardiogenic syncope? PE?

A

1) structural
2) arrhythmias
PE: SOB, palpitation

111
Q

How to tx cardiogenic syncope?

A

brady: pacemaker
tachy: defib
strucutral: surgery

112
Q

Pt is conscious during seizure? Tx?

A

simple partial seizure

tx: carbamezeprine, phenytoin, iamotrigine, topiarmate

113
Q

What are PE of simple partial seizure?

A

jacksonian march - starts small but moves to bigger muslce areas
todd: local paresis

114
Q

Pt is unconscious during seizure? Tx?

A

complex partial seizure

tx: carbamezeprine, phenytoin, iamotrigine, topiarmate

115
Q

Child is “staring off” in class? Tx?

A

absence/petit mal seizure

tx: ethosuximid

116
Q

Pt has muscle contractions + ictal cry -> contract relax -> regains consciousness+ incontenience? What are the phases called? Tx?

A

generalized tonic-clonic seizure/grand mal
tonic, clonic, post-ictal
tx: levetiracteam(Keppra)

117
Q

Pt keeps bobbing head? Risk?

A

atonic seizure

risk: head injury

118
Q

What is associated with myoclonic seizure?

A

metabolic disorders
anoxic brain injury
CNS dz

119
Q

How to dx fake seizure from real?

A

EEG

120
Q

What is status epilpiticus?

A

lasting 5-30 min without returning to baseline

more than 2 unprovoked seizures

121
Q

Pt ran out of carbemezapine? What is bad about it?

A

generaliezd status epilepticus

bad: irreversible neuronal damage

122
Q

Pt has muscle weakness and noticed having trouble buttoning shirt? What to expect on PE?

A

amyotrophic lateral sclerosis - Lou gehrig

PE: loss of DTR but sensory intact, NO pain

123
Q

How to dx amyotrophic lateral sclerosis?

A

increase in serum creatinine kinase

MRI

124
Q

How to tx amyotrophic lateral sclerosis?

A

supporitve

125
Q

How to differentiate between wernicke and broca?

A

wernicke- parrot: able to repeat but does not understand

broca - cannot talk but understands words

126
Q

Pt suddenly has loss of one sided facial motor fxn? Tx?

A

bell’s palsy

tx: supportive

127
Q

Pt has herpes zoster - what to be on the look out for? Where to look? Tx?

A

ramsay hunt
look in ear
Tx: antivirals

128
Q

Pt has PAIN on face? PE? Tx?

A

trigeminal neuralgia
NO sensory loss
tx: carbamazepine, pheyntoin

129
Q

What dz have sensory in tact on face?

A

bell palsy

trigeminal neuralgia

130
Q

Axon or demylination can be recoverd?

A

demylination

131
Q

Small or large - pain, burning? - numbness, pins and needles?

A

pain - small

pins and needles - big

132
Q

Pt has fever + nuchal rigidity + change in mental status + HA?

A

bacterial meningitis OR encephalitis

133
Q

What are the bugs for infants - bacterial meningitis?

A

e coli
beta hemolytic strep (Group B)
listeria monocytogenes

134
Q

What are the bugs for children/adults - bacterial meningitis?

A

S penumo
N minigitidis
h influenza

135
Q

What are PE for meninigitis?

A

brudzinki neck sign - lift the head and the knee lifts too
kernig sign - lift the leg up but the knee cannot extend
ICP - papilledema

136
Q

Who are at risk for bacterial meningitis?

A

army

college dorms

137
Q

How to dx meningitis?

A

CSF analysis

138
Q

How to tell between bacterial and aspetic meningitis?

A

CSF analysis

bacterial: higher WBC, higher proteins, less glucose- bacteria eat sugar and poop proteins

139
Q

What is important to get before tx meningitis?

A

ALWAYS GET BC BEFORE GIVING ABX!

140
Q

What might be associated with meningitis?

A

encephlaitis

141
Q

How to tell between meningitis and encephalitis?

A

CSF analysis!
bacterial meningitis vs viral: high WBC + protein, low glucose
if trying to differentiate between viral and encephalitis - get a CSF PCR THEN MRI

142
Q

How to tx encephalitis?

A

supportive

143
Q

What are the different viral encephalitis?

A

herpes simplex encephalitis
cytomegalovirus encephalitis
HIV

144
Q

Pt has rapid progressive dementia? Types?

A

prion dz

  • creutz jakob (mad cow)
  • kuru (from eating brain)
  • scarpie (in sheep)
145
Q

What are AIDs pts at risk for -infxn in the brain?

A

fungal dz

146
Q

Pt has TB and back pain? Imaging? Tx?

A

epidurla abscess -secondary
CT/MRI
medical emergency - drain + IV Abx

147
Q

Pt has severe sinusitis + AOM, at risk for? Dx and Tx?

A

subdural abscess OR brain abscess- bacterial infxn from sinus/middle ear
MRI-abscess
surgery and IV abx

148
Q

Pt with syphilis or lyme dz is at risk for what CNS infxn?

A

tabes dorsalis

149
Q

What are sx for tabes dorsalis?

A

loss of vibration

150
Q

Pt went swimming in warm lake are at risk for what infxn? Bug?

A

primary amoebic meningoencephalitis (PAM)

bug: naegleria floweri

151
Q

Pt has diplopia and DESCENDING flaccid paralysis + alert and oriented? Tx?

A

botulism
tx: close monitoring with respiratory support
+/- antitoxins

152
Q

What is botulism?

A

gram positive

toxin blocks Ach release

153
Q

What are the classifications for botulism?

A

food borne
wound
intestinal - infants w/ honey

WHOLE PT (19 decks)

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