Hon-High Yield Review Flashcards
CT’s can miss 5-10% of SA hemorrhages and __ may be needed if the CT is normal in someone with a “worrisome hx” or abnormal HA exam
LP
What is the intensity of a Common migraine?
What is the age of onset of Common migraine?
What is the gender ratio of Common migraine?
What is the duration of Common migraine?
What is the location of Common migraine?
Is there Aura with common migraine?
Intensity=Moderate to severe Age of onset=Late teens to early 20's; prevalence peaks 35-50 yrs Gender=F:M of 3:1 Duration=4-72 hrs, usually 12-24 hrs Location=UNILATERAL or bilateral Aura: None
What are the most common associated symptoms with Common migraine?
Nausea (90%)
Vomiting (33%)
How long does a Classic Migraine usually last?
What other associated symptoms with Classic migraine?
Do these have aura?
15-30 min, sometimes longer
Commonly visual symptoms (scintillations, scotoma)
With aura
Describe the following for Tension-Type HA:
- Intensity?
- Age of onset?
- Frequency of episodic vs chronic types?
- Duration of episodic vs chronic types?
- Location?
- Description?
- Aura?
Intensity-mild to moderate
Age of onset-Variable; generally peak incidence 20-40 yrs
Frequency episodic 15 days/month
Duration episodic several hrs, chronic type all day with wax and wane
Location-BIFRONTAL, BIOCCCIPITAL, neck, shoulders, band-like
Description-Dull, aching, squeezing, pressure
-No prodrome or aura
Describe the following of a Cluster HA:
- Intensity?
- Gender ratio?
- Other associations?
- Monthly frequency (episodic vs chronic)?
- Duration?
- Location?
- Intensity-SEVERE, EXCRUCIATING
- F:M-1:6
- Recent association with obstructive sleep apnea (use CPAP)
- Episodic=1 or more attacks/day for 6-8 wks; Chronic=several attacks per week without remission
- 30 mins-2 hr
- 100% UNILATERAL; GENERALLY ORBITOTEMPORAL (ICEPICK IN THE EYE)
What are contraindications for triptan usage in tx of migraine?
-Documented or strong risk factors for ischemic heart disese, other CV, cerebrovascular, or peripheral vascular disease, Raynauds, uncontrolled HTN, hemiplegic or basilar migraine, severe renal or hepatic impairment, use within 24 hr of tx with ergotamines, MAOIs, or other 5-HT1 agonists
What are some preventative tx of migraines?
- Antidepressants: TCAs, SSRIs, MAOIs
- Beta blockers
- Anticonvulsants
What is the only FDA approved preventive tx for Tension HA?
BOTOX
Describe the type of pain associated with Trigeminal neuralgia, daily frequency, and tx:
Excruciating, sharp, shooting, electrical quality occuring in paroxysm
Often frequent throughout the day
Tx is usually Carbamazepine or Oxcarbamazepine
Describe what ischemic and hemorrhagic strokes look like on CT:
Ischemic=Dark
Hemorrhagic=White
Describe the emergent dx and tx of stroke:
- ABC’s
- Acute HTN is common in acute ISCHEMIC stroke and in most cases should NOT BE TREATED
- IV access: IVF’s should NOT INCLUDE GLUCOSE as hyperglycemia is associated with worse neuro outcomes
What can mimic a stroke?
Seizure, migraine, hypoglycemia
What are some clinical situations in which warfarin is generally indicated?
- A fib
- Prosthetic valve
- MI
- Atrial septal defect
- Hypercoaguable state
- Large vessel disease
- Aortic arch disease
Describe the epidemiology of MS:
- Affects women > men (1.5:1) with women having a more favorable course, generally
- Onset between age 15-50 (average age onset=29) –> earlier onset is generally favorable prognosis
- Waxing and waning = exacerbations and remissions
Although an LP isn’t definitive, what are CSF findings that may aid in making clinical diagnosis of MS?
-Presence of oligoclonal bands and/or increased IgG
MS is diagnosed by ___
Multiple lesions over space and time
What are drugs used for “maintenance/Disease modifying” in MS (decrease frequency and severity of exacerbations and slow disease progression? Which pts are these for?
- Avonex, Rebif (Interferon Beta-1A)
- Betaseron (Interferon Beta-1B)
- Copaxone (Glatirimer acetate)
These meds used in pts with relapsing remitting MS. Betaseron is the only 1 approved for chronic progressive MS
What meds are used to treat an acute exacerbation in MS?
High dose corticosteroids (Solumedrol) followed by Prednisone taper
It is nearly impossible to differentiate a first time MS attack from ADEM. When would MS be the more likely diagnosis when comparing to ADEM?
ADEM should NEVER recur. If pt develops future symptoms or new lesions on MRI, MS is the more likely dx
What is 1st line tx for spasticity in MS?
Baclofen
What can you tx urinary urgency in MS with?
Oxybutynin, Detrol LA
What is the single most important piece of information necessary to dx epilepsy?
HISTORY of the event(s)-preferably by witness
Which drugs can be used for both partial onset and generalized seizures?
Valproic acid Lamotrigine Topirimate Leviteracetam Zonisamide Perpampanel
Which drug is for petit male seizures only?
Ethosuximide
What is the #1 reason for breakthrough seizures?
Poor med compliance
Pallor, sweating, abnormal head sensation, lightheadedness, position-related, slow onset, and brief unconsciousness are characteristic of ___
Syncope
Urinary or bowel incontinence, tongue injury, tonic/clonic movements, postictal state are characteristic of ___
Seizure
What is the most common bradykinetic disorder?
Idiopathic PD
What are the cardinal features of idiopathic PD?
- Tremor: gen resting tremor, often unilateral at first, “pill-rolling” quality; may see mouth or chin tremor but not the whole “head”
- Rigidity: increased resistance to passive movement; “cogwheel” rigidity
- Bradykinesia: slowness of movement; often difficulty initiating movement
___ is characterized by bradykinesia and rigidity as well as loss of voluntary control of eye movements (esp vertical gaze)
PSP
___ is characterized by bradykinesia and rigidity as well as Pronounced autonomic dysfunction
MSA
__ is characterized by both cortical and basal ganglionic dysfunction, bradykinesia and rigidity, and may also see cortical sensory loss, apraxia, myoclonus, or aphasia
CBD
___ is irregular, brief, “dancelike” movements; may be incorporated into purposeful movements
Chorea
__ is writhing, sinuous movements (often occur in combo with chorea)
Athetosis
___ is sustained muscle contractions that produce twisting and repetitive movements and abnormal postures
Dystonia
__ is large amplitude, flinging movement, usually from the proximal part of an extremity
Ballism
__ is a brief, rapid, repetive, seemingly purposeless stereotyped action that may involve single or multiple muscle groups
Tics
Idiopathic torsion dystonia can be treated with ___
Low doses of levodopa
___ may be helpful to weaken involve muscles and is probably the tx of choice for focal torsion dystonia
BOTOX injections
Wilsons disease is a disorder of __ metabolism that produces __ dysfunction
Copper
Neurologic and hepatic
Wilsons disease is characterized by decreased binding of copper to __ leading to large amounts of free Cu deposited into tissues
It usually presents in __
Cerruloplasmin
Childhood or young adult life (Young persons disease)
What are clinical features of wilsons disease?
BOTH bradykinetic and hyperkinetic features
What are consequences of diagnosing or not diagnosing Wilsons disease?
If caught=cure
If not=death
How can you diagnose Wilsons disease?
- increased amts of Cu excretion in 24 hr urine collection
- decrease serum cerruloplasmin level
- Kayser-Fleischer ring in eye exam
How do you treat wilsons disease?
Penicillamine (copper-chelator)
-Restrict dietary Cu
Diffuse Lewy Body disease has this tetrad of symptoms:
Dementia
Parkinsonian symptoms (generally bradykinesia and rigidity without tremor
Prominent psychotic symptoms (usually visual hallucination)
**Extreme sensitivity to antipsychotic agents
Dementia w/ PD symptoms –> Old-person disease
In Diffuse Lewy body disease, mild to moderate Parkinsonian features are often present early in the disease. Bradykinesia, rigidity, and falls are often prominent. __ is often absent and response to __ therapy is often poor
Tremor
Levodopa
Most pts with diffuse lewy body disease experience severe, potentially life-threatening adverse rxns if treated with __ agents
Antipsychotic
If antipsychotic truly needed, use one of the newer agents like Seroquel or Zyprexa
Compare the following in Parkinsons vs Diffuse Lewy Body Disease:
Location of Lewy bodies: __
When dementia occurs: ___
Resting tremor? ___
Autonomic dysfunction? ___
Hallucinations with/without anti-PD drugs? ___
PD=MIDBRAIN lewy bodies; Lewy body disease=Cortical lewy bodies
PD=Executive dementia sometimes late in illness; Lewy body disease=Cortical dementia always occurs early in illnesss
PD=Resting tremor usually present; Lewy body disease=Resting tremor usually absent
PD=Autonomic dysfunction sometimes seen; Diffuse lewy body disease=autonomic dysfunction prominent
PD=Hallucination only in response to anti-PD drugs; Lewy body disease=Hallucinations common in absence of anti-PD drugs
What is the triad of symptoms of normal pressure hydrocephalus?
- Dementia
- Gait disturbnance
- Urinary incontinence
Normal pressure hydrocephalus is potentially reversible with __
Ventriculoperitoneal shunting (gait disturbance is the most likely to be reversed with shunting)
___ has a typical age of onset of 40-50 yrs of age, is a hereditary stroke disorder with a defect in NOTCH3 on Chr 19 causing progressive degeneration of smooth muscle cells in blood vessels. It commonly manifests as migraines and TIAs or strokes. Eventually progresses to Subcortical Dementia. No specific tx exists but antiplatelet agents and minimizing risk for vascular disease can be helpful
CADASIL
___ has an unknown cause, characterized by amnesia only for a few hours (3-4), no other focal neurologic signs, all tests are normal, self-resolving, and almost never recurs
Transient global amnesia
What are some Worrisome signs AKA signs which may indicate HA of pathologic origin (Secondary HA)?
- Worst HA ever (berry aneurysm) –> CN III palsy with PCoA rupture
- Onset of HA after age 50
- Atypical HA for pt
- HA w/ fever
- Abrupt onset (seconds to minutes)
- Subacute HA w/ progressive worsening over time
- Drowsiness, confusion, memory impairment
- Weakness, ataxia, loss of coordination
- Paresthesias/sensory loss/paralysis
- Abnormal medical or neuro exam
