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Neuro. CM3 > Everything Else - Starred > Flashcards

Everything Else - Starred Flashcards

1
Q

Small axons carry what three sensations

A

Autonomic fibers: light touch, pain and temperature

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2
Q

Most common complaint of peripheral neuropathies:

A

Numbness and tingling and the hands and the feet

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3
Q

Severe long standing neuropathies can lead to:

A
  • Ulcers

- Loss of hair and trophic changes *LESIONS

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4
Q

Peripheral mononeuropathies vs. polyneuropathies:

A

Mono: CN (bell’s)
Poly: Systemic (Guillain-Barre, DM)

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5
Q

Who is Bell’s palsy more common in?

A

Pregnant women and elderly

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6
Q

What is Bell’s associated with disease wise?

A

HSV-1, Lymes and Varicella Zoster (presence of lesions too)

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7
Q

CN 7 palsy PE findings (3):

A
  • Cannot close the affected eye
  • Cannot raise the corner of the mouth on affected side
  • Loss of nasolabial fold on affected side
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8
Q

Treatment of mild Bell’s palsy:

A

Prednisone taper + eye drops

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9
Q

Treatment of severe Bell’s palsy:

A

Prednisone taper + eye drops + acyclovir

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10
Q

Most common form of Guillain-Barre Syndrome:

A

AIDP: Acute inflammatory demyelinating polyradiculoneuropathy

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11
Q

Physiology of Guillain-Barre Syndrome:

A

Following an infection (or other event like pregnancy) - autoimmune reaction with peripheral nerves that causes demyelination

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12
Q

Most common infection that causes GBS?

A

Campylobacter jejuni

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13
Q

Common presentation of GBS:

A

Symmetric muscle weakness - legs then arms (ascending)

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14
Q

What are DTRs like in GBS?

A

They are absent or depressed

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15
Q

Other symptoms of GBS include:

A

Autonomic (tachycardia, arrythmias, sweating)

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16
Q

To diagnose GBS, what three tests do you order?

A
  • CSF (elevated protein, normal cells)
  • Serum IgG
  • MRI/electrophysiology
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17
Q

You do not use steroids to treat:

A

GBS - can delay recovery

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18
Q

Treatment of GBS:

A

Plasmapheresis or IVIG

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19
Q

How long does GBS last?

A

4 weeks - it has to run its course

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20
Q

What are Chronic inflammatory demyelinating polyneuropathies?

A

Like GBS but not as severe - no ICU

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21
Q

What is Mononeutiris Multiplex?

A

Form of damage to one or more peripheral nerves - is a syndrome NOT a disease

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22
Q

Three diseases that can damage nerves and cause Mononeuritis Multiplex?

A
  • Diabetes
  • Vasculitis
  • CT disorders - RA
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23
Q

Vitamin B12 is called:

A

Cobalamin (folic acid deficiency)

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24
Q

Most common cause of Vitamin B12 deficiency:

A

Pernicious anemia

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25
Q

Defining feature of Vitamin B12 def.:

A

Hyperreflexia with absent achilles reflexes

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26
Q

Antibodies to what two types of cells will be found in someone with pernicious anemia:

A

Antibodies to:

  • Intrinsic factor
  • Parietal cells
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27
Q

Vitamin B12 treatment:

A
  • IV for a week
  • Dose every week for four weeks
  • Dose every month for life
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28
Q

If on any of the four drugs, you need a folate supplement:

A
  • Methotrexate
  • Phenytoin
  • Trimethoprim
  • Metformin
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29
Q

Vitamin B12 deficiency produces a megaloblastic anemia (high MCV) and can cause:

A

Neurological defecits

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30
Q

Vitamin B1 (thiamine deficiency) results in:

A

Beriberi

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31
Q

Difference between dry and wet beriberi in Vitamin B1 deficiency:

A

Dry: Symmetrical peripheral neuropathy
Wet: Symmetrical peripheral neuropathy + cardiac manifestations

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32
Q

What does thiamine do?

A

Initiates the nerve pulse that is independent of its coenzyme functions

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33
Q

What does vitamin B6 (pyridoxine) do?

A

Neurotransmitter synthesis

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34
Q

What two things inhibit Vitamin B6?

A
  • Isoniazid

- Hydralazine

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35
Q

Three characteristics of Vitamin B6 deficiency:

A
  • Seborrheic dermatitis
  • Glossitis and stomatitis
  • Microcytic hypochromic anemia
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36
Q

Pellagra (niacin B3) deficiency is commonly seen in:

A

alcoholics

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37
Q

Two PE findings of pellagra?

A
  • Red tongue

- Red (sunburn) rash on exposed skin areas

38
Q

Most common cause of neuropathy in the US:

A

Diabetes Mellitus

39
Q

Autonomic neuropathies affect 50% of diabetics - Symptoms include:

A
  • GI dysmotility
  • Cardiac arrhythmias
  • GU dysfunction (bladder)
40
Q

Best way to prevent worsening of the diabetic neuropathy:

A

Glucose control

41
Q

Treatment for painful Diabetic Neuropathy:

A
  • AEDs (gabapentin)
  • TCAS
  • SNRI
  • Lidocaine, caspacin
42
Q

Post herpetic neuralgia persists over:

A

1 month of the resolution of a rash

43
Q

ABCD2 scoring system for stroke:

A 
A: >60
B: BP >140/90
C: (1 speech), (2 unilateral weakness)
D: (2 points if over 60 mins)
D2: (1 point diabetes)
44
Q

Admit with ABCD score of:

A

3 or more

45
Q

Classic definition of stoke:

A

Ischemic (thromboembolism)

46
Q

If you are thinking stroke, want a CT without contrast why?

A

To look for bleeding, not the stroke

47
Q

What is paradoxus embolus?

A

Venous embolus through the arterial system (fat or air from surgery)

48
Q

What are lacunar strokes?

A

less than 1 cm - endothelial damage from HTN or DM

49
Q

With ischemia of the vertebral artery you can experience (2):

A
  • Vertigo

- Contralateral body, ipsilateral face loss (sensory)

50
Q

With Basilar artery problems, what four clinical signs can you have?

A
  • Dysarthria
  • Hemi/quad paresis
  • LOC
  • Ipsilateral gaze deviation (moves away from side of stroke)
51
Q

If you think someone is having a stroke, what lab must you order?

A

Glycemic - A hypoglycemia state of 30 can look like a stroke

52
Q

What is a stroke in evolution?

A

Worsening in first 24 - 48 hours

53
Q

NIH stroke scale scoring:

A 
0: no stroke
1-4: minor
5-15: moderate
15-20: moderate/severe
21-42: severe
54
Q

Imaging systems to evaluate the carotids when someone has a stroke:

A

Carotid duplex ultrasound

*Carotid enderectomy (CEA) is gold standard

55
Q

If you suspect a Subarachnoid hemorrhage you order a CT stat and a:

A

Lumbar puncture

56
Q

Best stroke center acronym:

A

ACSC

57
Q

Primary therapy for stroke:

A

TPA - Thrombolysis (rt-TPA Ateplase)

58
Q

Inclusion criteria for use of TPA with stroke:

A

Must be used within 4.5 hours

59
Q

Want to get IV TPA started under:

A

60 Minutes

60
Q

What is endovascular therapy?

A

Can be used as a proximal treatment when a patient has missed the window for regular TPA

61
Q

When do you hold aspirin in a stroke patient?

A

You hold for the first 24 hours if they are having TPA

62
Q

When should a patient have warfarin instead of ASA? (3):

A
  • A-fib
  • Prosthetic heart valve
  • Intra-cardiac thrombi
63
Q

Is there data with heparin use in stroke?

A

NO - only for DVT prophylaxis

64
Q

Target blood pressure for a stoke patient:

A

<185/<110

65
Q

Initiate hypothermia in stroke patients for the first:

A

12-24 hours after a stroke

66
Q

What medication increases the risk of hemorrhagic transformation?

A

TPA (Aspirin does not)

67
Q

Three resin factors for a hemorrhagic transformation:

A
  • Large infarct
  • Hypertension
  • Use of thrombolytics/anticpagulants
68
Q

Treatment for brain edema from a large stroke (2):

A
  1. Diuresis (Mannitol)

2. Surgery

69
Q

Most powerful risk factor for stroke:

A

HTN

70
Q

Risk factor for stroke with CAD and CHF:

A

x3 CAD

x4 CHF

71
Q

What medication do we want a stroke patient on for prevention (3):

A
  • statin (atorvostatin 80 mg)
  • ASA + dipyridamole
  • BP/DM control
72
Q

After a stroke you can restart BP drugs after:

A

24 hours

73
Q

all patients should be referred to what after a stroke?

A

PT, OT, Psych, social workers

74
Q

Who is most at risk demographically for a stroke, who dies?

A
  • AA x2 (AA males 45-54 x3)

- Women die from stroke more than men - they do not have a higher risk for CA

75
Q

Genetics to predispose to intraparenchymal hemorrhage:

A

APOE E2 and E4 - amyloid deposition

76
Q

Causes of intrapenchymal hemorrhage (4):

A
  • Cerebral amyloid antipathy
  • Vascular malformations
  • Drugs (cocaine/meth)
  • Anticoagulation therapy (warfarin)
77
Q

What has headaches related to stoke and what does not?

A

Interparenchymal hemorrhage has a HA 50% of the time, ischemic strokes do not have HA

78
Q

Assume what in someone with intraparenchymal hemorrhage?

A

C spine injury - keep at 30 degrees and maintain euvolemia (CVP 5-12)

79
Q

If seizures post stroke, what do you prescribe?

A

Phenytoin

80
Q

Blood pressure ranges post stroke:

A
  1. HTN <130
  2. Post-op <110
  3. DON’T let anyone below 90
81
Q

Subarachnoid hemorrhage caused by (cause 5-10% of all strokes):

A

Saccular/berry aneurysm (80%)

82
Q

PE findings with someone SAH (4):

A
  • Flame hemorrhages in the eye
  • Thunderclap, worse HA ever
  • Complaint of previous sentinel HA
  • Nuchal rigidity
83
Q

What are you looking for in the CSF with someone that has SAH?

A

Xanthocromia (hemoglobin break down of blood)

84
Q

What can you do to treat the SAH (5)?

A

Clip, coiling, nimodipine, BP control (100-110)

85
Q

Complications of SAH (4):

A
  • Vasospasm**
  • Hyponatremia - NOT SIADH
  • Neurogenic cardiac stunning
  • Hydrocephalus
86
Q

How do you treat vasospasm after SAH (can cause stroke 14-20%)?

A

Triple H: Hypertension (induce with pressers), hypervolemia, and hemodilution

87
Q

SAH two defining characteristics from ischemic and intraparenchymal findings:

A
  • Worse HA of my life

- decreased LOC

88
Q

What is a sentinel HA?

A

Before a SAH and rupture - get CT and LP to check

89
Q

Most common roots for PHN

A

T4-6

90
Q

Complex regional pain syndrome affects ___ from the site of damage

A

Distally

91
Q

PE findings of CRPS

A

Skin changes, nail changes, vascular abnormalities, joint stiffness

92
Q

Treatment of CRP2/1

A

Opioids, prednisone, NSAIDS

Neuro. CM3 (11 decks)

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