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Exam 2 Flashcards

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1
Q

stroke mimics vs stroke symptom patterns

A

mimics are less likely to follow predictable pattern based on blood vessels

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2
Q

when to initiate ASA for primary prevention

A

adults 50-59 who have >10% CVD risk, are not at increased risk for bleeding, and have a life expectancy of at least 10 yyears

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3
Q

when should adults be screened for hyperlipidemia

A

all adults age 40-75

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4
Q

who should be screened for hypertension

A

all adults >18

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5
Q

criteria for orthostatic changes

A

reduction of systolic or diastolic BP of at least 20 or 10 mmHg respectively. +/-increase of pulse by 20 bpm. These changes should be seen 3 minutes after a patient who was supine sits or stands up

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6
Q

what is TUG test

A

timed up and go. Pt sits in a chair and then stands up without using their arms, then walks 10 feet and back and sits down again

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7
Q

normal TUG score

A

<10 seconds

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8
Q

average duration of Todds paralysis

A

15 hours

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9
Q

what is a cardiogenic stroke

A

decrease in cerebral perfusion caused by decreased cardiac output, severe hypotension, or hypoxemia

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10
Q

what is a thrombotic stroke

A

native clot within the intracranial vasculature

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11
Q

most common major vessel occlusion in stroke

A

MCA

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12
Q

what percentage of strokes are ischemic

A

87%

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13
Q

what % of ischemic strokes are small vessel lacunar

A

25%

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14
Q

what % of ischemic strokes are embolic

A

57%

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15
Q

describe intracerebral hemorrhage

A

arterioles/small arteries bleed producing a localized hematoma that can spread along white matter pathways

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16
Q

etiologies of intracerebral hemorrhage

A

HTN, trauma, coagulopathy, stimulant use, vascular malformations

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17
Q

etiology of SAH

A

rupture of arterial berry aneurysm at base of brain (90%), or vascular malformations lying near pial surface

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18
Q

what % of SAH presents with sentinel bleed

A

30%

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19
Q

common sites of large artery atherothrombotic strokes

A

bifurcation of common carotid, MCA stem

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20
Q

etiology of large artery strokes

A

atherosclerosis, vasoconstriction, arterial dissection

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21
Q

ssx in large vessel atherothrombotic strokes

A

often fluctuate due to circle of willis collateral circulation

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22
Q

embolic strokes ssx

A

abrupt onset with early maximal ssx

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23
Q

multiple sites of embolic stroke indicate what source

A

cardiac

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24
Q

subcategories of embolic strokes

A

known cardiac or aortic source, arterial source

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25
Q

locations for lacunar strokes

A

basal ganglia, subcortical white matter (internal capsule), pons

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26
Q

etiology of lacunar strokes

A

HTN, atherosclerosis

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27
Q

risk factors for lacunar strokes

A

HTN, DM, smoking

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28
Q

first signs of systemic hypoperfusion CVA

A

cortical blindness, stupor, weakness of shoulders/thighs with sparing of face and distal limbs

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29
Q

what is true of fever and stroke

A

fever is an atypical stroke ssx, each 1 degree C increase in temp increases risk of poor outcome by 2.2

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30
Q

when must tPA be initiated (per laura)

A

within 3 hours

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31
Q

rate of hemorrhage after tPA

A

6%, about half of these are fatal

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32
Q

ACA stroke ssx

A

contralateral leg>face and arm weakness, frontal signs

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33
Q

MCA CVA ssx

A

contralateral: face and arm>leg weakness, sensory loss to all modalities, visual field cut, neglect. Ipsilateral: Gaze preference. Dominant hemisphere affected: Aphasia, alexia, agraphia

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34
Q

PCA CVA ssx

A

contralateral homonymous hemianopia. With thalamic involvement: sensory loss to all modalities

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35
Q

AICA CVA ssx

A

contralateral: hemiparesis and hemisensory loss of pain and temp. Ipsilateral: ataxia

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36
Q

PICA CVA ssx

A

contralateral: hemibody pain and temp loss.
ipsilateral: Facial pain, hemifacial pain/temp loss, ataxia, nystagmus, N/V/vertigo, horner’s syndrome, dysphagia. Hiccups

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37
Q

basilar artery CVA ssx

A

bilateral: quadriplegia, facial weakness, lateral gaze weakness with sparing of vertical gaze (locked in syndrome)

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38
Q

vertebral artery CVA ssx

A

contralateral: hemibody weakness, loss of DCML.
Ipsilateral: tongue weakness and/or atrophy, Wallenberg syndrome

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39
Q

vertebral artery supplies

A

medial and lateral medulla

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40
Q

basilar artery supplies

A

pons

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41
Q

PICA supplies

A

lateral medulla

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42
Q

PCA supplies

A

occipital lobe

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43
Q

intracerebral hemorrhage tx

A

ICU admission to maintain eunatremia, normoglycemia, normothermia, normotension, treat seizures, surgical eval. For ICP: Raise head of bed, +/-mannitol. For HTN (only if SBP>200 or MAP>150): labetalol, nicardipine, esmolol

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44
Q

SAH tx

A

early surgical clipping

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45
Q

subdural treatment

A

burr hole vs watchful waiting, extensive rehab

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46
Q

epidural tx

A

removal of clot if > 1 cm

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47
Q

intracerebral hemorrhage vs SAH: pressure

A

ICH is lower pressure bleed limited by ICP. SAH is higher pressure bleed

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48
Q

causes of aneurysms

A

genetic, gender, HTN, smoking, atherosclerosis

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49
Q

what is a thrombus

A

clot developed in place

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50
Q

what is an embolus

A

piece of clot that is free to move

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51
Q

what is an atheroma

A

plaque of thickened arterial intima occurring atherosclerosis

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52
Q

name of score used to assess risk of stroke after TIA

A

ABCD2

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53
Q

ABCD2 stands for

A

Age (>60), Blood pressure (>140/90), Clinical features (unilateral weakness=2, speech difficulty=1), Duration (>60 mins = 2, 10-59 mins = 1, <10 = 0) Diabetes

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54
Q

what ABCD2 score is low, moderate, high risk

A

3 or fewer is low risk. 4-5 moderate. 6 or greater is high risk.

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55
Q

components of FAST

A

Face, arms, speech, time

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56
Q

initial CVA eval

A

non-con CT, other studies (labs, ECG, chest xray, etc)

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57
Q

depression criteria mnemonic

A

SIG E CAPS plus either a depressed mood or loss of interest/pleasure

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58
Q

SIG E CAPS

A

Sleep (insomnia/hypersomnia), Interest (anhedonia), Guilt, Energy (fatigue), Concentration, Appetite (increased or decreased), Psychomotor (agitation or retardation), Suicidal ideation

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59
Q

risk factors for suicide

A

Family and/or personal history of suicide attempt, mental illness, substance abuse, recent hardship

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60
Q

what is dysthymia

A

depressed mood for most days during the past 2 years

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61
Q

what is bipolar II

A

one or more hypomanic episodes and at least one major depressive episode

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62
Q

what is cyclothymia

A

2 year period of cycling hypomanic ssx and depressive ssx that fail to meet criteria for MDD

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63
Q

what is a mixed state

A

meets criteria for both manic episode and major depressive episode almost every day for at least one week

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64
Q

length of time for hypomanic episode

A

4 days

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65
Q

what types of anxiety disorders prevalent in older adults

A

OCD, panic disorder, PTSD

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66
Q

what is psychosis

A

a break with reality, involving hallucinations, delusions, disorganized thinking, bizarre behavior, or catatonia

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67
Q

important diagnostic consideration in psychosis

A

can be primary or secondary, must rule out delirium

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68
Q

what are hallucinations

A

apparent sensory perceptions in the absence of sensory stimuli

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69
Q

what are delusions

A

firmly held, false beliefs

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70
Q

types of delusions

A

persecutory, grandiose, religious, somatic, thought control

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71
Q

delusions/hallucinations and Alzheimers

A

50% of AD patients experience them in the first 3 years

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72
Q

what is disorganized behavior/thought

A

behavior that is chaotic, poorly directed, without a clear goal or purpose, or directed toward some bizarre end. Thought lacks logical connection

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73
Q

what is catatonia

A

state of immobility, resistance to attempts to be moved, mutism

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74
Q

steps in psychosis eval

A

r/o physical illness, family history, mental status exam, medical eval, psychological tests

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75
Q

what is the most common type of psychosis in dementia

A

paranoid delusions

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76
Q

what to know about treating psychosis in dementia

A

antipsychotics carry a black-box warning for increased mortality in dementia patients

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77
Q

what are cluster A personality disorders and examples

A

odd/eccentric: paranoid, schizoid, schizotypical

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78
Q

what are cluster B personality disorders and examples

A

dramatic/emotional/erratic: Antisocial, borderline, histrionic, narcissistic

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79
Q

what are cluster C personality disorders

A

anxious/fearful: avoidant, dependent, obsessive compulsive

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80
Q

which types of personality disorders are most common in elderly

A

clusters A and C

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81
Q

what is true about aging and personality disorders

A

most have been present but undiagnosed throughout life, but age can worsen them

82
Q

diagnosis consideration of personality disorders in elderly

A

must r/o reversible causes

83
Q

hoarding aka

A

disposophobia

84
Q

what is palliative care

A

interdisciplinary approach to relieve suffering and obtain the best quality of life possible

85
Q

who is approved for hospice

A

terminally ill with life expectancy less than 6 months as certified by 2 MDs

86
Q

criteria for admission to hospice

A

physiologic impairment of functional status per palliative performance score, dependence on assistance for 2 or more ADLs, co-morbidities that may lead to less than 6 months to live, specific disease states (cancer, COPD, liver failure, HIV)

87
Q

what is most common symptom of critical illness

A

pain

88
Q

other ssx of critical illness

A

dyspnea, anorexia, cachexia, constipation, nausea, anxiety, delirium, depression, fatigue

89
Q

how to treat pain on hospice

A

avoid NSAIDs and methadone, use the same drug for breakthrough pain (ie oxycontin with oxycodone immediate release)

90
Q

considerations for pain management on hospice

A

consider declining renal and hepatic function, manage constipation, discuss tolerance

91
Q

treatment strategies for dyspnea on hospice

A

add O2 if possible, use a fan, opioids, roxanol (liquid morphine), +/-benzos

92
Q

treatment strategies for GI discomfort on hospice

A

assess for fecal impaction before using laxatives, fiber does not help, consider risks/benefits of artificial nutrition/hydration

93
Q

how to treat death rattle

A

liquid glycopyrolate

94
Q

what is capacity

A

situation-specific ability of a patient to consent to or refuse care

95
Q

4 elements of decision making

A

understanding (comprehend relationship of intervention/outcome), appreciation (risks vs benefits), reasoning (compare alternatives and consequences), expressing choice

96
Q

highest risk group for suicide

A

men >85 y/o

97
Q

what is reduplicative paramnesia

A

the belief that the present environment is duplicated or moved from another location

98
Q

what is the most frequent complication of hospitalization

A

delirium

99
Q

delirium criteria

A

disturbance of consciousness with reduced ability to focus, sustain, or shift attention/ A change in cognition or the development of a perceptual disturbance that develops over a short period of time and fluctuates and is believed to be caused by an underlying organic condition or is iatrogenic.

100
Q

features of delirium

A

acute onset, fluctuating course, inattention, disorganized thinking, altered level of consciousness

101
Q

what to rule out when considering delirium

A

dementia, depression, mania, acute psychosis

102
Q

pharmacological management for delirium ssx (only for safety concerns)

A

haldol

103
Q

components of initial eval for delirium

A

history/physical with neuro exam, vital signs, labs (thyroid panel, B12, drug levels, tox screen, ammonia, cortisol, ABG), search for occult infection, review meds. +/-brain imaging, LP, EEG

104
Q

nonpharm strategies for management of delirium

A

reorientation, encourage family involvement, use of sitters, eyeglasses/hearing aids, sleep hygiene, encourage fluids, maintain mobility/self care

105
Q

hallmark of delirium

A

impaired attention (attention is preserved in dementia until final stages)

106
Q

character of hallucinations in delerium vs acute psychosis

A

delirium: usually visual. Acute psychosis: usually auditory and more complex

107
Q

geriatric depression scale 4 or less

A

absence of significant depression

108
Q

geriatric depression scale 5-7

A

borderline depression

109
Q

geriatric depression scale 7 or more

A

probable depression

110
Q

what is encephalopathy

A

syndrome of global brain dysfunction with a spectrum of disturbances ranging from subtle confusion to stupor, coma, and death

111
Q

types of progressive encephalopathy

A

intrinsic, extrinsic, metabolic

112
Q

types of nonprogressive encephalopathy

A

trauma, acute hypoxia

113
Q

greatest risk factor for dementia

A

age

114
Q

additional risk factors for dementia

A

HTN, head trauma, hyperlipidemia, hypoxia, smoking, stroke, depression, ETOH, hypothyroidism

115
Q

Alzheimer’s areas of difficulty

A

learning new info, finances, visio-spatial impairment, lost in surroundings

116
Q

fronto-temporal dementia etiology

A

loss of spindle neurons

117
Q

fronto-temporal dementia aka

A

Pick’s disease

118
Q

fronto-temporal dementia ssx

A

loss of social awareness, inhibition. compulsive behaviors, loss of executive function and insight into deficits. Frontal release signs

119
Q

what are frontal release signs

A

palmomental reflex, palmar grasp reflex, rooting reflex (later signs)

120
Q

what is the palmomental reflex

A

chin twitches if you stroke the thenar emanence

121
Q

causes of vascular dementia

A

untreated HTN, DM, hyperlipidemia, CAD

122
Q

vascular dementia ssx

A

confusion, agitation, depression, unsteady gait, memory disturbances, urinary ssx, night wandering, difficulty planning and organizing, poor attention/concentration

123
Q

1st and 2nd most common forms of dementia

A

AD and vascular

124
Q

vascular dementia tx

A

prevent future CVAs

125
Q

lewy body dementia ssx

A

visual hallucinations, cognitive dysfunction, fluctuating levels of attention, REM sleep behavior disorder, autonomic dysfunction, parkinsonism

126
Q

what is progressive multifocal leukoencephalopathy

A

rapidly progressive lesions gradually demyelinate white matter, due to infection, chemo, other drugs (usually seen in immunosuppressed)

127
Q

characteristics of Creutzfeldt-Jakob

A

prion disease causing encephalopathy that is rapidly progressive and usually fatal within one year of onset

128
Q

alcoholic encephalopathy areas affected

A

cortical and cerebellar (frontal, limbic or both)

129
Q

what is wernicke’s

A

acute medial cortical amnestic syndrome with coma, ocular palsies, irregular pupils, ataxia

130
Q

what is Korsakoff

A

profound amnesia (retrograde and anterograde) with clearing of aphasia, spatial disorientation, and apraxia

131
Q

labs when evaluating dementia

A

CBC, chemistries, TSH, vitamin B12, folate, RPR, MRI head, LFTs, UA

132
Q

what is executive function

A

planning, attention, memory, motor skills

133
Q

what are ADLs

A

care of self (bathe, groom, feed, toilet)

134
Q

what are IADLs

A

care of close environment (use phone, pay bills, drive, shopping, cleaning)

135
Q

when to refer dementia patients to neuro

A

combination of psychosis and dementia, patients with early ssx for accurate diagnosis, whenever the diagnosis is in doubt

136
Q

what is true of behavioral ssx in vascular dementia

A

they can be hard to control

137
Q

how to delay or prevent need for psychotropic drugs in dementia

A

environmental control

138
Q

functional scale for dementia

A

FAST

139
Q

when to initiate hospice for dementia patients

A

be at least FAST 7c and have all features of stages 6a-7c

140
Q

genes associated with alzheimers

A

PS-1, PS-2 (early-onset), various polymorphisms of APO-E

141
Q

postmortem pathology findings of Alzheimers

A

accumulation of extracellular amyloid and intraneuronal neurofibrillary tangles

142
Q

late onset alzheimers initial presentation

A

confusion, depression, delusions, visual hallucinations

143
Q

pathology subtypes of fronto-temporal dementia

A

ubiquitin-positive inclusions and tau inclusion

144
Q

what % of strokes occur >65 y/o

A

75%

145
Q

who under the age of 75 is more likely to have a stroke

A

women

146
Q

typical stroke presentation

A

facial droop, speech, motor, mental status, depending on location

147
Q

common stroke mimics

A

hypoglycemia, infection, syncope, migraine, drugs, acute MI, trauma

148
Q

how to rule out bacterial endocarditis as cause of stroke

A

ESR

149
Q

what is amaurosis fugaz

A

transient monocular vision loss

150
Q

most common presentation of lacunar stroke

A

pure motor deficit

151
Q

appearance of lacunar infarct on CT

A

small, punched out hypodense areas

152
Q

what is the scale used to predict Pt’s recovery following stroke

A

NIH stroke scale

153
Q

what NIH score predicts high probability of death/disability vs good outcome in stroke

A

> 16 is bad, <6 is good

154
Q

what is true of advanced age and tPA

A

age alone is not a cause for the risk outweighing benefit

155
Q

when does stroke recovery reach a plateau

A

3 months

156
Q

secondary prevention after stroke due to intracranial atherosclerosis

A

dual antiplatelet x 90 days, then ASA

157
Q

what does ACA supply

A

medial surface of frontal lobe to anterior parietal lobe, including medial somatosensory cortex

158
Q

what does MCA supply

A

lateral convexity of cerebral cortex, including lateral portion of primary motor and somatosensory cortex. Lateral temporal lobe and some parietal lobe

159
Q

what does PCA supply

A

inferior and medial portions of temporal and occipital lobes

160
Q

most common cause of nontraumatic intracerebral hemorrhage in elderly

A

amyloid angiopathy

161
Q

what is the most common overall cause of intracerebral hemorrhage

A

HTN

162
Q

intracerebral hemorrhage ssx

A

slower onset (minutes-hours) of HA, N/V, focal neuro ssx, AMS

163
Q

subdural etiology

A

tearing of bridging veins 2/2 trauma

164
Q

subdural ssx

A

gradual increase in neuro ssx including AMS and pupil abnormalities

165
Q

subdural imaging

A

concave bleed that can cross suture lines

166
Q

subdural tx

A

surgical evacuation of >5 mm of midline shift

167
Q

3 classic phases of epidural

A

brief LOC, lucid interval, neurologic deterioration

168
Q

epidural ssx

A

HA, vomiting, aphasia, hemiparesis, seizure, uncal herniation (CN III palsy)

169
Q

epidural imaging

A

lens/lemon shaped bleed that does not cross suture lines

170
Q

epidural tx

A

evacuation of hematoma or craniotomy

171
Q

ssx of unruptured aneurysm

A

pain above and behind eye, numbness, weakness, paralysis on one side of face, vision changes. May be transient

172
Q

examples of intrinsic encephalopathy

A

degeneration, chronic HTN, changes in brain matter due to changes in blood supply

173
Q

examples of extrinsic encephalopathy

A

hydrocephalus, tumors

174
Q

risk factors for delirium

A

elderly, polypharmacy, changes in environment, prior episode of delirium, underlying cognitive impairment, comorbidities, male, low activity levels

175
Q

causes of delirium

A

use of indwelling catheters, physical restrains, malnutrition, dehydration, iatrogenic events, infection, depression, pain, sleep deprivation, critical illness

176
Q

most common cause of creutzfeldt-jakob

A

sporadic mutation

177
Q

creutzfeldt jakob imaging, EEG

A

cortical ribboning, hockey stick sign, cortical cytotoxic edema. Spike wave complexes on EEG

178
Q

alzheimers imaging

A

medial temporal lobe atrophy, can be generalized

179
Q

what is the most sensitive exam for alzheimers

A

MOCA, can use SLUMS if not certified

180
Q

clock test is an assessment of _____

A

visuospatial impairment

181
Q

which syphilis test can be used on CSF

A

VDRL

182
Q

what is FTA-ABS test

A

confirmatory testing for syphilis after positive VDRL/RPR

183
Q

what is amyloid beta protein precursor test

A

test done on CSF which will be low in Alzheimers

184
Q

what is APOE4 test

A

a test done a CSF that will likely be low in high-risk for Alzheimers disease

185
Q

what palliative performance score indicates eligibility for hospice

A

70% or less

186
Q

obsessive compulsive personality disorder ssx

A

ego-syntonic, preoccupation with orders and details without obsessions or compulsions, rigid, stubborn, serious

187
Q

obsessive compulsive personality disorder is most common in _____

A

men

188
Q

dependent personality disorder ssx

A

inability to assume responsibility, dependent or submissive behavior, fear of being alone, difficulty making decisions

189
Q

what is avoidant personality disorder ssx

A

intense fear of rejection leading to social inhibition, shy, isolated

190
Q

narcissistic personality disorder ssx

A

grandiose, excessive sense of self-importance, superiority, lack of empathy

191
Q

histrionic personality disorder ssx

A

attention seeking, overly emotional, temper tantrums, inappropriate sexual behavior, needs praise, relationships feel closer than they are

192
Q

borderline personality disorder ssx

A

unstable self-image and relationships, mood swings, black and white thinking, intense reactions, fear of abandonment, impulsivity

193
Q

antisocial personality disorder ssx

A

failure to conform to social norms, disregard of rights of others, aggression toward others, exploitation for personal gain, recklessness, lack of remorse

194
Q

schizotypal personal disorder ssx

A

odd, eccentric, bizarre behavior and thought pattern, magical thinking

195
Q

schizoid personality disorder ssx

A

anhedonia, social withdrawal, odd appearance

196
Q

paranoid personality disorder ssx

A

distrust and suspiciousness of others, interprets motives as malevolent, thinks benign remarks are threatening

197
Q

drug for PTSD nightmares

A

prazosin, must start low and titrate slow

198
Q

most common phobia in elderly

A

fear of falling

199
Q

what is the screening test for elder abuse

A

elder abuse suspicion index

200
Q

risk factors for elder abuse

A

functional disability, cognitive impairment, abuser substance abuse/mental health problems, abuser dependence, social isolation, history of violence

agm 4 (2 decks)

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