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Neurology_Clinical Medicine > Headaches, Dementia, Truama > Flashcards

Headaches, Dementia, Truama Flashcards

1
Q

What is the difference between delirium and dementia?

A

Delirium is acute while dementia is progressively worsening impairment of intellectual functioning

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2
Q

What are some causes of delirium?

A

Not being able to see light, medications, trauma. Most commonly seen after surgery and inpatient setting.

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3
Q

When is the Montreal Cognitive Assessment (MOCA) used?

A

To assess cognition when there is a a concern

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4
Q

What is the time that you ask a patient to draw on the MOCA?

A

10 past 11

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5
Q

What score is considered normal on the MOCA?

A

> 26 points is normal

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6
Q

What is a moderate cognitive score on the MOCA?

A

4-11

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7
Q

How do you work up dementia?

A

Blood work and imaging (CT for acute and MRI w/contrast for progressive)

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8
Q

Who is likely to have low thiamine levels?

A

Chronic alcohol drinkers

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9
Q

How many states of decline of cognition on mental testing is most often in Alzheimer’s Dementia?

A

Declines in 2 areas (on MOCA)

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10
Q

What are acetylcholinesterase inhibitors (Donepezil) role in treating Alzheimers dementia?

A

Does not cure, but delays disease progression and may improve memory

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11
Q

What drug class do you add to acetylcholinesterase inhibitors in the treatment of Alzheimer’s dementia?

A

NMDA (Memantine)

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12
Q

When do dementia symptoms get worse?

A

Sundowning (nighttime)- not processing day and nighttime

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13
Q

What is the pathophysiology of vascular dementia?

A

Lack of blood flow in small areas of the brain leading to ischemia and lacunar infarcts

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14
Q

What are some of the presentation characteristics in the cortical subtype of vascular dementia?

A

Speech difficulty
Loss of ADLS
Confusion
Amnesia
Poor executive function

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15
Q

What are some of the presentation characteristics in the subcortical subtype of vascular dementia?

A

Motor deficit
Gait changes
Urinary incontinence
Personality changes

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16
Q

How are you going to treat vascular dementia?

A

Treat underlying hyperlipidemia and hypertension. If symptoms of insomnia, depression or agitation are present treat as well.

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17
Q

What type of neurological/psychological symptom can lewy body dementia cause?

A

Hallucinations

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18
Q

Does dopamine medication help with lewy body dementia symptoms (hallucinations, anxiety, delusions)?

A

No, need to prescribe a cholinesterase

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19
Q

What are symptoms of frontotemporal dementia?

A

Euphoria, apathy, disinhibition and compulsions (hypersexual)

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20
Q

What is the treatment for frontotemporal dementia?

A

No curative treatment

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21
Q

What usually causes pseudodementia?

A

depression or anxiety

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22
Q

What is the treatment for pseudodementia?

A

SSRI’s and counseling

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23
Q

What are some of the medications used to treat hallucinations/agitation in dementia?

A

Zyprexa
Seroquel
Risperdal

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24
Q

What are some of the medications used to treat weight loss or lack of appetite in dementia?

A

Antipsychotics
Cyproheptadine (anti-histamine)
Remeron

25
Q

What is always the first assessment in a head trauma?

A

ABCDE

26
Q

What is priapism and why is this concerning in head trauma?

A

An erection, abnormal response to head trauma

27
Q

What is the top score on the Glasgow Coma Scale?

A

15

28
Q

What is a score for a comatose patient on the Glasgow Coma Scale?

A

8 or less

29
Q

What is a score for someone who is totally unresponsive on the Glasgow Coma Scale?

A

3 (No response on eye response, verbal response, and motor response)

30
Q

What is a dead person’s score on the Glasgow Coma Scale?

A

3

31
Q

Do you order a head CT with or without contrast in a head trauma?

A

Without contrast

32
Q

What is vomiting indicative of in a head trauma?

A

Brain bleed

33
Q

What are the reasons you are getting a head CT in a children over the age of 2?

A

GCS < 15
Signs of Basilar Skull Fracture
AMS (agitation, somnolence, slow response, repetitive questions)

34
Q

What are the reasons to initiate shared decision making (observation vs. CT) in a head trauma in a child over 2 years?

A

Vomiting
LOC
Severe HA
Severe MOI (fall > 5 ft)

35
Q

What are the reasons you are getting a head CT in a child less than 2 years in a head trauma?

A

GCS < 15
Palpable skull fracture
AMS (agitation, smnolence, slow response, repetitive questioning)

36
Q

What are the reasons to initiate shared decision making (observation vs. CT) in a head trauma in a child under 2 years of age?

A

Scalp hematoma (excluding frontal)
LOC > 5 seconds
Not acting normal per parent
Severe MOI (fall > 3 ft)

37
Q

What are the symptoms of subarachnoid hemorrhage?

A

Sudden “thunderclap” headache, usually unilateral, nausea, vomiting

38
Q

What are some of the meningeal signs of subarachnoid hemorrhage?

A

Photophobia, confusion, neck stiffness

39
Q

What are the treatments for subarachnoid hemorrhage?

A

Admit to hospital for observation, stool softeners (phenytoin), and BP control (Nimodipine)

40
Q

What is mass effect?

A

Something is pressing one side of the brain to the other

41
Q

If you have a patient with a epidural hematoma what is the most common blood vessel that was damaged?

A

Middle meningeal artery

42
Q

What is the cause of subdural hematoma?

A

Venous bleeding between dura and arachnoid from torn bridging veins

43
Q

What symptoms should not be seen in a concussion?

A

Pupil size change, strength changes, hemiparesis, or visual field deficit

44
Q

What should be the GCS on a patient with a standalone concussion?

A

13-15

45
Q

What is the recommend period of complete rest after a concussion?

A

24-48 hours (this does not mean return to sports)

46
Q

How long should a patient use an NSAID for headache symptoms after a concussion?

A

Only the first few days, after should not use because there is a risk for rebound HA

47
Q

What is the treatment for prolonged headaches in concussion?

A

PT

48
Q

What are the “red flags” descriptions of headaches?

A

Thunderclap headache
Worst headache of life
Trauma
Anticoagulation use
Decreased level of consciousness
Suspicion of meningitis

49
Q

What defines a migraine headache?

A

Unilateral headache with pulsating/throbbing moderate severe pain

50
Q

What is an aura?

A

Visual disturbance such as seeing lines, dots, blurring or loss of peripheral vision lasting several minutes

51
Q

When can you not prescribe birth control in patients with migraine?

A

Patients with a diagnosis of Migraine with Aura

52
Q

What do you use for treatment in moderate to severe migraine flares?

A

Triptan medications (Sumatriptan)

53
Q

In an emergent situation of migraine, what can you give to prevent recurrence?

A

Dexamethasone IV

54
Q

What treatment are used for migraine prophylaxis?

A

Antihypertensives (Propranolol)
Antidepressant (Amitriptyline)
Anticonvulsants (Topiramate or Gabapentin)
CGRP antagonists (Rimegepant or Amimovig)

55
Q

What drug class targets the trigeminal nerve in migraine prophylaxis?

A

CGRP antagonists, a newer drug class of medications

56
Q

What is the treatment for cluster headaches?

A

100% O2 is first line

57
Q

What is the presentation of a cluster headache?

A

Severe, unilateral periorbital pain (can have congestion, conjunctival injection) and not improved by rest, patient will be pacing

58
Q

What can an exertional headache secondary to?

A

Malignancy, intracranial hemorrhage, or aneurysm (need to order an MRI)

Neurology_Clinical Medicine (13 decks)

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