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AGM 4 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

cauda equina triad

A

urinary retention, stool incontinence, saddle anesthesia

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2
Q

Parkinsonism definition

A

at least 2 of the following: resting tremor, bradykinesia, rigidity, loss of postural reflexes, flexed posture, freezing phenomenon

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2
Q

Parkinsonism definition

A

at least 2 of the following: resting tremor, bradykinesia, rigidity, loss of postural reflexes, flexed posture, freezing phenomenon

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3
Q

4 categories of parkinsonism

A

primary, secondary, parkinsonism-plus, heredodegenerative

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4
Q

what is primary parkinsonism

A

parkinsons disease (sporadic or genetic)

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5
Q

examples of parkinsonism-plus disorders

A

progressive supranuclear palsy, diffuse lewy body

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6
Q

examples of secondary parkinsonism

A

parkinsonism caused by drugs, toxins, tumors, normal pressure hydrocephalus

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7
Q

examples of heredodegenerative parkinsonism

A

alzheimers, huntingtons, wilson’s

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8
Q

3 clinical clues suggestive of primary PD

A

asymmetric onset, responds to levodopa, resting tremor

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9
Q

how to tell primary PD vs parkinons-plus

A

Parkinsons plus will have other neuro findings and will not respond to therapy

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10
Q

Parkinons onset

A

insidious, progressive, worse when under stress. May be intermittent at onset

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11
Q

Parkinsons etiology

A

degeneration of dopamine producing cells in substantia nigra causing decrease in presynaptic domapine

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12
Q

PD diagnosis

A

no lab tests. Try l-dopa trial. MRI/CT to rule out other disease

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13
Q

PD peak age of onset

A

60

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14
Q

PD lifetime risk with and without family history

A

with: 4% without: 2 %

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15
Q

life expectancy after PD diagnosis

A

20 years

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16
Q

cause of death with PD

A

concurrent illness such as aspiration

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17
Q

life expectancy with PD plus disorders

A

9 years

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18
Q

what % of patients with PD develop dementia

A

78%

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19
Q

definition of PD dementia

A

PD for at least 1 year before dementia starts

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20
Q

Diffuse lewy body dementia definition

A

PD for less than 1 year before dementia

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21
Q

common cause of dementia in PD

A

depression

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22
Q

type of tremor in PD

A

resting, pill-rolling

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23
Q

type of handwriting with PD

A

micrographia

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24
Q

posture in PD

A

flexed, stooped, loss of posture reflex

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25
Q

emotional ssx in PD

A

apathy, anxiety, depression

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26
Q

sensory ssx in PD

A

numbness/tingling, pain in affected extremity

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27
Q

sleep ssx in PD

A

disturbed REM sleep with thrashing/kicking, may precede onset of PD

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28
Q

what primitive reflex is present in PD and what is this called

A

Glabellar (persistent blinking while tapping forehead). Myerson’s sign

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29
Q

gait in PD

A

narrow-based, shuffling, decreased arm swing

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30
Q

when does the wearing off effect occur for levodopa

A

after 5-10 years

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31
Q

2nd line treatment for PD

A

dopamine agonists

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32
Q

dopamine agonist examples

A

pergolide, bromocriptine, cabergoline

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33
Q

dopamine agonist side effects

A

fibrosis, hallucinations, confusion, sleep attacks, impulse control problems

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34
Q

Myasthenia gravis etiology

A

IgG antibodies against nicotinic Ach receptor in post-synaptic neuromuscular junction

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35
Q

age of onset for MG in women

A

20-40

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36
Q

age of onset for MG in men

A

age 40-60

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37
Q

MG presentation at onset

A

ptosis without pupillary involvement

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38
Q

MG ssx

A

muscle fatigability that improves with rest that begins centrally (usually with eye/face ssx)

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39
Q

MG is associated with____ how are these diagnosed

A

thymoma, thymic hyperplasia. CT

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40
Q

test for MG

A

Ach receptor antibody

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41
Q

what to do if seronegative MG suspected

A

test for muscle-specific receptor tyrosine kinase, or tensilon test

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42
Q

EMG findings in MG

A

normal or increased jitter; repetitive nerve stimulation shows >10% decrement

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43
Q

what is tensilon

A

IV short-acting Ach esterase inhibitor

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44
Q

MG treatment

A

low-dose immunosuppression (5 mg prednisone daily then titrate to effect), azathioprine, Ach esterase inhibitors, plasmapheresis, IVIG, thymectomy

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45
Q

how much CSF is produced per hour

A

20 ml

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46
Q

how does CSF leave brain

A

drains via arachnoid granulations into venous system

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47
Q

etiology of normal pressure hydrocephalus

A

unclear, could be decreased draining 2/2 fibrosis from injury/bleed/infection

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48
Q

normal pressure hydrocephalus triad

A

Adam’s triad: gait instability, urinary incontinence/urgency, dementia

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49
Q

characteristics of gait in NPH

A

slow, short steps, shuffling, wide stance

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50
Q

which ssx comes first and second in NPH

A

first: gait instability, second: urinary ssx

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51
Q

characteristics of dementia in NPH

A

inattention, slow recall, decreased spontaneity

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52
Q

imaging findings for NPH

A

ventriculomegaly with preserved volume of brain parenchyma

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53
Q

NPH tx

A

VP shunt

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54
Q

Guillain-Barre etiology

A

autoimmune demyelination of peripheral nerves following minor infection or associated with SLE, Hodgkins

55
Q

GB demographic

A

equally in both sexes, age 30-50

56
Q

GB presentation

A

rapidly progressive (in hours to days) tingling, muscle weakness, paralysis affecting both sides of body that starts in legs and spreads to arms with absent reflexes and autonomic instability

57
Q

GB tests

A

lumbar puncture, EMG

58
Q

GB tx

A

plasmapheresis, IVIG, blood thinners, respiratory support, supportive care

59
Q

GB prognosis

A

most people recover completely but may take anywhere from weeks to years

60
Q

what % of ALS cases are genetic

A

10%

61
Q

what is ALS

A

upper and lower motor neuron disease in which the neurons die

62
Q

ALS ssx

A

muscle twitching, weakening, paralysis that is progressive

63
Q

what is not affected by ALS

A

senses, bowel/bladder function, cognition

64
Q

ALS physical exam findings

A

weakness, tremors, spasms, atrophy, stiffness, clumsiness, emotional incontinence, abnormal reflexes

65
Q

ALS tx

A

first line: riluzole to slow progression. Symptomatic meds: Baclofen/diazepam for spasticity, amitriptyline to decrease saliva

66
Q

ALS prognosis

A

death often occurs within 3-5 years

67
Q

ALS variants

A

progressive muscular atrophy, primary lateral sclerosis

68
Q

how to test L4/L5 innervated muscles

A

resist patient’s abducted leg at lateral upper thigh to test gluteus medius, resist pt’s ability to dorsiflex foot (tibialis anterior), resist great toe extension (extensor hallucis longus)

69
Q

how to test L5/S1 innervated muscles

A

Overcome hip extension (gluteus maximus), resist patient’s ability to evert foot (peroneus muscles)

70
Q

abnormalities in muscle strength of L4-S1 innervated muscles indicates

A

lumbar disc disease or lumbar spinal stenosis, sciatica

71
Q

vertebral compression fractures ssx

A

upper thoracic may be asymptomatic, lower thoracic/lumbar: point tenderness and pain but no neurologic abnormalities

72
Q

red flags for back pain due to systemic disease

A

age >70, recent trauma, unexplained weight loss/fever, immunosuppression, history of cancer, osteoporosis, prolonged use of glucocorticoids, disabling/progressive focal deficits, ssx > 6 weeks, IV drug use

73
Q

vertebral compression fracture tx

A

activity modification, pain control (opioids, NDSAIDs, calcitonin), PT, fall prevention, treat underlying osteoporosis

74
Q

triad of cauda equina

A

urinary retention, stool incontinence, saddle anesthesia

75
Q

L2 dermatome

A

groin

76
Q

L3 dermatome

A

anterior thigh

77
Q

L4 dermatome

A

anterior/lateral thigh, medial leg

78
Q

L5 dermatome

A

lateral/posterior thigh, lateral leg, dorsal foot

79
Q

S1 dermatome

A

posterior thigh, posterior leg, plantar foot

80
Q

C2 dermatome

A

temporal/parietal scalp

81
Q

C3 dermatome

A

nec

82
Q

C4 dermatome

A

neck and medial shoulder

83
Q

C5 dermatome

A

top of shoulder, lateral upper arm

84
Q

C6 dermatome

A

radial forearm, thumb, index, long fingers

85
Q

C7 dermatome

A

long and ring fingers, upper back around scapula

86
Q

C8 dermatome

A

ulnar forearm, ring and small fingers

87
Q

when to refer for spinal surgery

A

loss of bowel control, inability to urinate, saddle anesthesia, profound weakness, ataxic/myelopathic gait

88
Q

when to refer to nonsurgical treatment for back pain

A

mild weakness, back pain without radiculopathy, radicular numbness/pain

89
Q

imaging to evaluate compression fracture

A

AP/lateral plain films

90
Q

positive straight leg test indicates what

A

herniated disc as cause of pain

91
Q

what is a positive straight leg raise test

A

patient experiences sciatic pain when straight leg is at angle between 30 and 70 degrees when Pt is supine and knee is straight

92
Q

what does a positive Hoffmans sign indicate

A

hyperreflexia

93
Q

what constitutes a positive Hoffman’s sign

A

thumb and fingers flex

94
Q

imaging for disc herniation at L3/L4

A

cannot see on x-ray, needs MRI

95
Q

myelopathy vs myelomalacia

A

myelopathy is due to extrinsic compression of cord that is symptomatic but may be reversible. Myelomalacia is when the cord becomes atrophic and gliotic as a result of chronic injury and is irreversible

96
Q

main types of headaches

A

primary, secondary, other

97
Q

headache red flags

A

duration < 6 months, age <5 or >50, acute onset, atypical ssx, rash, neuro deficit, vomiting, recent trauma, infection, HTN, immunosuppression, pregnancy

98
Q

red flag physical exam findings for headache

A

elevated BP, decreased neck ROM, signs of head trauma, loss of vision, unequal pupils, focal deficits

99
Q

characteristics of migraine without aura

A

duration up to 3 days, unilateral, pulsing, moderate to severe pain, N/V, photo/phonophobia

100
Q

migraine with aura characteristics

A

visual disturbances, paresthesias, speech problems

101
Q

tension headache duration

A

up to one week

102
Q

tension headache ssx

A

bilateral, tight, mild to moderate, not aggravated by activity, no N/V or aura

103
Q

cluster headache onset and duration

A

peaks in 10 minutes, lasts up to 3 hours

104
Q

cluster headaches ssx

A

excruciating, piercing/stabbing, unilateral, periorbital, restless

105
Q

labs for dizziness

A

CBC, CMP, thyroid, B12, BGL

106
Q

what is tabes dorsalis

A

demyelination due to untreated syphilis

107
Q

tabes dorsalis onset

A

may be decades after initial syphilis infection

108
Q

tabes dorsalis ssx

A

weakness, diminished reflexes, neuropathic pain, ataxia, joint degeneration, personality changes, positive Rombers

109
Q

tabetic gait

A

high-stepping gait with Pt’s feet slapping the ground due to lack of proprioception

110
Q

pupillary finding in tabes dorsalis

A

argyll robertson pupil

111
Q

what is charcot foot

A

sudden softening of the bones in the foot that can occur in people who have neuropathy, leading to fractures and arch collapse giving the foot a rocker-bottom appearance

112
Q

demographic for trigeminal neuralgia

A

classically women over 50

113
Q

branches of trigeminal nerve

A

ophthalmic, maxillary, mandibular

114
Q

what is trigeminal neuralgia

A

severe pain to one or more branches of trigeminal nerve due to compression near the pons, often by an enlarged superior cerebellar artery

115
Q

trigeminal neuralgia tx

A

carbamazepine, baclofen, lamotrigine, other anticonvulsants, amitriptyline, opiates

116
Q

Bells palsy treatment

A

steroids, antivirals if appropriate, protect eye

117
Q

onset of diabetic peripheral neuropathy

A

within 15-20 years, or sooner with poor glucose control. Distal to proximal

118
Q

diabetic peripheral neuropathy ssx

A

sensory ataxia especially at night

119
Q

ssx of neuropathy due to nutritional deficiency

A

distal, symmetric sensory, motor, and autonomic findings especially painful dysthesia

120
Q

nutritional causes of neuropatyh

A

deficiencies of thiamine, B6, B12, niacin, folic acid

121
Q

percentage of dialysis patients suffering from neuropathy

A

60%

122
Q

infectious causes of neuropatyh

A

HIV, herpes zoster, guillain-barre, lyme disease

123
Q

most common cause of peripheral neuropathy

A

diabetes

124
Q

BPPV etiology

A

likely dislodged otoconia (calcium granules)

125
Q

BPPV ssx

A

episodic vertigo, nystagmus, nausea precipitated by changes in head position

126
Q

eval maneuver for BPPV

A

Dix-hallpike

127
Q

menieres disease aka

A

endolymphatic hydrops

128
Q

menieres disease ssx

A

recurrent vertigo, tinnitus, hearing loss, fullness in ear, usually unilateral

129
Q

menieres disease tx

A

diuretic, send to ENT

130
Q

1st line meds for migraine prevention

A

topiramate, amitriptyline, propranolol

131
Q

2nd line meds for migraine prevention

A

gabapentin, verapamil, neuro consult

132
Q

1st line meds for tension/cluster HA prevention

A

amitriptyline

133
Q

2nd line meds for tension or cluster HA prevention

A

gabapentin, topiramate

134
Q

chronic causes of demyelinating peripheral neuropathy

A

DM, hypothyroid, multiple myeloma, liver disease, amiodarone

135
Q

chronic causes of axonal peripheral neuropathy

A

DM, uremia, B12 deficiency*, lyme disease, ETOG

136
Q

what medication to use for PD psychosis

A

quetiapine

AGM 4 (2 decks)

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