Hon Review of All the things Flashcards
what 3 symptoms classically make up meinere’s?
tinnitis, vertigo, hearing loss
pts with meinere’s present with? complain of?
low frequency hearing loss, fullness in ears, vertigo that comes in spells
vestibular problem with meinere’s?
horizontal + rotary nystagmus
what is considered a peripheral cause of vertigo?
the labyrinth (PNS starts at spinal cord and goes out)
what does Romberg’s test for?
proprioception, posterior columns (peripheral test for dorsal test of dorsal columns)
What age group is diagnosed with Freidrich’s ataxia? COD?
young people; cardiomyopathy
what does ataxia look like? how would a pt describe it?
disequilibrium, falling, poor balance, hyporeflexic, decreased m. strength
if a pt has a herniation syndrome what may be one of their symptoms?
pupil dilate
what kinds of things can be examined on a comatose pt?
pupillary light response, extra ocular movements, oculocephalic reflexes, corneal response, can try pain response: pinch nail bed, withdrawal to noxious stimuli, check breathing patterns
where can a lesion occur that would cause coma?
both sides of brain involved, brainstem or both, (lesion of bilateral cortex, midbrain/pons/medulla)
not coma causes: hypothalamus, spinal cord, MS lesions, unilateral BG, unilateral thalamus
what does it mean if there is an absent oculocephalic reflex when stimulated with cold on L and intact on R?
damage to gaze center in R pons
pt comes into ER after being found down by family members. Pt is sleepy, drowsy, can’t follow commands, eyes deviate to L, babinski found on R, lg L MCA stroke.
Neuro change hours later:
unarousable, L eye down and out, extensor posture, bilateral babinski.
What happened?
Uncal herniation L to R
what is common in the presentation of a pt with hepatic coma/encephalopathy?
both hemispheres affected, eyes adducted and down, asterictis (hyperextended at wrist, flicking)
cold water into the R ear of a coma pt?
normal= conjugately gaze to the R
migraines: more common in? characteristics?
in women, unilateral (or bilateral) throbbing/sharp/pressure, N/V, photophobia, phonophobia
What classifies a chronic migraine?
15-16days/month, 4+ months, hx of migraine HA,
what can be used to prevent migraine?
beta blockers Ca channel blocker AEDs: topiramate, valproic acid TCAs: amytriptiline, noratriptilline Botox** FDA approved
which sex more frequently as cluster HA? proven association with? symptoms? prodrome?
men; proven association with sleep apnea; periorbital pain, sharp/boring/penetrating pain, 30-90 mins, same time of year, recurring; burring nose/inner canthus ipsilateral side
description of trigeminal neuralgia?
unilateral, electric/sharp/shooting, 1+ division of trigeminal n., pain comes in paroxysms in seconds, few seconds and stops on/off thru day
what typically brings on trigeminal neuralgia?
chewing, talking, hot/cold liquids/foods
what meds are used to treat trigeminal neuralgia?
anticonvulsants: Carbamazepine***, oxcarbamazepine, gabapentin
what is the triad for parkinsons?
tremor, bradykinesia, rigidity
which symptom of PD first?
tremor, unilateral to start
what are the other parkinsonisms called?
akinetic rigid syndromes
what are the symptoms of Progressive Supranuclear Palsy?
bradykinesia, rigidity, eyes vertical gaze fail, volitional gaze impaired
clinical features of diffuse lewy body dz?
psychotic symptoms, visual (small animals/kids)= early feature, autonomic dysfunction, OFTEN FALLING, slow/stiff, festinating gait, MMSE may be normal (not much memory loss)
Ad symptoms?
early: memory loss, (missed appts, forget where objects are, can’t balance checkbook)
late: kids stealing from them, spouse cheating; mood= intermittent agitation
what may imaging reveal for AD?
may see generalized atrophy or may be normal for age (blood work will be normal)
What should you expect if a pt has intermittent episodes of encephalopathy, unexplained delirium, episodes lasting days?
lewy body
what would give away vascular dementia?
focality
what is the triad associated with normal pressure hydrocephalus? which improves with shunt?
dementia, gait disturbances, urinary abnormalities; gait improves with shunt
which kind of migraine has aura? why more common in women?
classic; hormones
what are the worrisome symptoms to make us suspect a secondary HA?
“worst HA of life,” atypical HA for pt, fever, focal symptom, late onset (>50-55), very rapid onset (secs to mins max intensity)
if a pt with a sudden severe HA collapses to ground unconscious and awakes in the ER with some weakness/lethargy what is our diagnosis until proven otherwise?
subarachnoid hemorrhage
order bloom work, CT (5-10% not seen on), LP can be done
description of wilson’s dz?
young person, liver and brain affected, copper metabolism deficiency, brady and hyperkinetic disorder
will one test show MS? what are some test results that may further lead you to suspect MS?
no; increased IgG synthesis with oligoclonal bands in CSF
what kind of dz is MS?
dz of young people 20-30s, exacerbations and remissions, dz of CNS: spinal cord and brain
what dz will have decrease arm swing?
PD
what are the dz modifying agents in MS?
IFNs, monoclonal antibodies, glaterimur acetate, -timizuab, dimethyl fumurate
what do steroids do in MS?
decrease the amount of time in exacerbation
How is MS diagnosed?
by multiple lesion over space and time
if a pt presents with optic neuritis and mono phasic lesions what should you think?
ADEM (acute disseminated encephalomyelitis); follow these pts closely as this may become MS (MRI 3-6 months)
What is the most common reason that someone with controlled epilepsy may have a seizure?
missed a medication
how many epileptic pts are controlled on first medication?
2/3
what is the most important thing in determining if a seizure or something else actually occurred?
hx with witnesses to event
which meds can treat both primary generalized or partial seizures?
valproic acid, lamotrigine, zonisamide, levotracetam
what are some things that can be confused with stroke?
hyper/hypoglycemia, hepatic abnormalities, MIGRAINES*
what meds help treat stroke?
aspirin, clopidigril, avernox
what does a CT of stroke pt look like at 3 hours? 2 days?
normal; hypodensity
what is the first approach to a pt?
ABCs
what are cases to tx with warfarin?
intermittent A fib, prosthetic valve, MI (EF 10-15%)
what are the features of ataxia telangectasia?
ataxia
telangectasia- spider veins
and sinopulmonary problems
pt comes in following first grand mal seizure. Had head/eye turn (automatism). Pt has had funny feeling in past but no seizure before. What does this tell us?
pt likely had partial seizures without generalization; pt had epilepsy
