LAST CLIN MED CARDS MUTHA TRUCKA Flashcards
(111 cards)
1
Q
What is defined as an acute confusional state with decreased attention?
A
Delirium
2
Q
What is a key feature of patients with delirium on physical exam?
A
Decreased attention
3
Q
How is delirium diagnosed?
A
Clinical diagnosis
4
Q
What are some medications that put people at risk for delirium?
A
Anti-cholinergics, sedatives/narcotics/benzodiazpines
5
Q
What does “sundowning” refer to?
A
Older people whose delirium symptoms get worse at night.
6
Q
How days after alcohol cessation do withdrawal symptoms peak?
A
2-3 days
7
Q
What does delirium tremens refer to?
A
Acute alcohol withdrawal syndrome
8
Q
How do we treat DT’s?
A
Benzodiazepines
9
Q
What percentage of people over the age of 70 have memory loss? What percentage over the age of 85?
A
10% of those > 70
20-40% of those >85 y/o
10
Q
What are some symptoms of dementia?
A
Depression, agitation, delusions, insomnia, disinhibition
11
Q
What is the greatest risk factor for dementia?
A
AGE
12
Q
Viral cause of dementia?
A
Cruetzfeldt-Jakob
13
Q
Is there a genetic link to dementia?
A
Yes, family history of apolipoprotein.
This is a mutant apolioprotein that may have implications in amyloid formation.
14
Q
What type of dementia is most common?
A
Alzheimer’s
15
Q
This disease is caused by neuritic plaques (“senile plaques”), amyloid (AB42 amyloid or simply “beta amyloid”) deposition in arterial walls of neurons.
A
Alzheimer’s
16
Q
People with this disease have a higher incidence of getting Alzheimer’s
A
Down Syndrome
17
Q
Does vascular dementia have an insidious or sudden onset?
A
Sudden
18
Q
What is an example of frontotemporal dementia?
A
Huntington’s
19
Q
Pick’s disease affects what part of the brain?
A
Anterior frontal and temporal cerebral cortex
20
Q
What kind of dementia has visual hallucinations and parkinson’s features?
A
Dementia with Lewy bodies
21
Q
What drugs do we use to treat dementia with lewy bodies?
A
Anticholinergic drugs
22
Q
I have gait ataxia, dementia, and urinary incontinence. On imaging, you see large ventricles. What do I have?
A
Normal Pressure Hydrocephalus
23
Q
How do we treat Normal Pressure Hydrocephalus?
A
Shunt
24
Q
Wernicke’s encephalopathy may be due to deficiency of what?
A
Thiamine
25
What syndrome explains the inability to recall recent memory despite immediate memory retention?
Korsakoff's syndrome
26
What does "punch drunk" refer to?
Dementia pugilistica -- boxers get this.
27
What is transient global amnesia?
When you're awake and fine and then later forget a moment of time.
28
According to the American Academy of Neurology, what labs should you get when working up dementia?
B12 and thyroid
29
If we are suspecting dementia, should we get imaging?
Yeah, CT or MRI should be considered
30
What is the most common cause of orthostatic hypotension?
Dehydration
31
What is the physiology behind orthostatic hypotension?
With aging, we lose the ability to vasoconstrict --- blood falls to feet and pools, we get dizzy and/or pass out
32
To say that someone has orthostatic hypotension, by definition, how much do numbers need to drop?
Fall in systolic BP by 20
Fall in diastolic BP by 10
Increase in heart rate 10-25 bpm
33
Young athlete passes out, what should be on your DDx?
Hypertrophic cardiomyopathy
34
What is the best treatment for true cardiac syncope?
Cardiac defibrillator
Also, cardio get out of neuro. I don't have time for you.
35
How will a nystagmus differ between a central and peripheral lesion?
Central lesion -- vertical nystagmus
| Peripheral lesion -- horizontal nystagmus
36
If you look at someone's nystagmus and it beats 2-3 times, should you be concerned?
No. 2-3 is normal.
37
Ok, patient has vertigo.
Will the nystagmus be toward or away from the lesion?
They fall, will they fall toward or away from the lesion.
Nystagmus -- AWAY
fall on their face -- TOWARD
38
Triad of Meniere's?
1. low frequency hearing loss
2. tinnitus
3. vertigo
39
How do we treat Meniere's?
1. Diuretics -- HCTZ
| 2. Low salt diet,
40
I say unilateral hearing loss, you say?
Acoustic neuroma
41
How do we diagnose an acoustic neuroma?
MRI
42
What test do we perform to test for BBPV?
Dix-hallpike maneuver
43
What maneuver do we do to treat BBPV?
Epley maneuver
44
Convinced a patient has orthostatic hypotension, but their BP doesn't show it when you test for it. What other test could you perform?
Tilt table test
45
What percentage of the population will experience a seizure in their lifetime?
5-10%
46
What type of seizure is described as a deranged area of cerebral cortex often due to a structural anomaly. Consciousness is preserved.
Partial
47
What type of seizure is described as "diffuse region of the brain firing simultaneously"?
General
48
These types of seizures may be motor, sensory, autonomic, psychic but without loss of consciousness.
Simple partial seizure
49
What type of seizure begins distally, and spreads proximally?
Jacksonian March
50
What is Todd's paralysis?
Local paresis lasting minutes to hours.
51
What type of seizure may continue for hours to days?
Epilepsia partialis continua
52
Tell me about the process of a complex partial seizure.
Often begins with an aura
Followed by ictal stage --> chewing, picking
Post ictal confusion
53
If you have a partial seizure with secondary generalization, what part of the brain is this most likely occurring in?
Frontal lobe
54
Are absence seizures partial or generalized?
General
55
Absence seizures:
1. Do you lose consciousness?
2. Do you experience post-ictal confusion?
1. you DO lose consciousness
| 2. you DO NOT experience post-ictal confusion
56
What age to absence seizures start?
4-8 y/o or early adolescence
57
What is the difference between an absence seizure and an atypical absence seizure?
symptoms last longer, more motor features
58
What percentage of patient with epilepsy experience grand mal seizures?
10%
59
When is a seizure is due to metabolic derangement, what type of seizure will it most likely be?
Grand mal
60
What will the tonic phase look like on EEG?
Increased low voltage and high amplitude
61
What will the clonic phase look like on EEG?
spike and wave activity develops
62
What type of seizure will show hippocampal sclerosis?
Mesial Temporal Lobe Epilepsy
63
50% of new onset seizures in adults is caused by?
cerebrovascular disease
64
Drugs that increase GABA function?
Benzodiazepines, phenobarbitol
65
What drug is good for partial seizures, post herpetic neuralgia, and neuropathic pain?
Gabapentin
66
When might we consider stopping seizure meds?
If the patient is low risk, has one seizure and is then seizure free, normal exam, and normal EEG.
67
What is the name for a continuous seizure?
Status elipticus
68
Intrancranial vasoconstriction is responsible for?
causing the migraine "aura"
69
headache results from _______ _________ and distension of cranial nerves (external carotid) with activation of perivascular pain fibers.
rebound vasodilation
70
What are some migraine triggers?
Sex, emotional stress, lack of sleep, foods, odors, missed meals, menstruation
71
What does expanding scotoma and scintillating margin refer to?
Expanding scotoma: blindspot
Scintillating margin: visual hallucinatins
72
How do we explain a complex migraine?
Prolonged aura with neurologic deficits lasting 1 hour up to a week.
73
What are three big things that tryptans do?
1. Turn off release of serotonin
2. Vasoconstrict
3. Turn off activation of CNS
74
If your patient is experiencing a severe headache, what is the best way to administer medication?
Injection -
75
What is the most common type of headache?
Tension
76
What type of headache is described as intense unilateral, orbital, supraorbital, or temporal head pain?
Cluster headache
77
Effective treatment for cluster headaches?
100% oxygen for 15 minutes
78
What drug do we use for PPx treatment of cluster headaches?
CCB! Verapamil
79
Most common cause of chronic daily headache?
Medication overuse -- polypharmacy.
PA school in my opinion.
80
Which intracranial mass lesion has the worst prognosis?
Gliomas
81
Why has the incidence of stroke decreased?
Better control of HTN
82
What is the most common cause of death in patients with cerebrovascular disease?
Myocardial infarction
83
Number one risk factor for stroke?
Hypertension
84
50% of all ischemic strokes is caused by?
Atherosclerosis
85
20% of all ischemic strokes are caused by?
A fib
86
Major risk factor for lacunar infarcts?
Hypertension
87
Lacunar infarcts will look like what on CT?
punched out lesions
88
A single embolus for a cardiac source will likely require full ________ for life.
anti-coagulation
89
Do strokes typically present with warning symptoms?
No
90
if you experience a middle cerebral artery stroke on the dominant side of your brain, what symptom are you likely to have?
Aphasia
91
if you experience a middle cerebral artery stroke on the non-dominant side of your brain, what symptoms are you likely to have?
Anosognosia (denial/neglect of deficit)
Speech and comprehension preserved
92
What is amaurosis fugax?
fleeting blindness
93
If i'm experiencing leg weakness and gait disturbance, where is my stroke most likely to be?
Anterior cerebral artery
94
True or False
We are really concerned about controlling BP when people present with stroke symptoms.
False. unless over 200 systolic and 100 diastolic.
the brain will auto-regulate
95
What is a screening tool for evaluating common carotid and origin of internal carotid artery?
Carotid doppler ultrasound
96
What is the most accurate test/imaging for evaluating common carotid and origin of internal carotid artery?
Arteriography
97
When do we consider a carotid endarterectomy?
When they are a good surgical candidate and they have greater than 70% stenosis.
98
How do we treat lacunar infarcts?
We treat the shit out of their HTN and hyperlipidemia.
99
What are the indications for full anticoagulation?
1. Embolus from the heart
| 2. A fib > 72 hours
100
CT scan is usually diagnostic for hemorrhagic stroke, however, what other test might you do to r/o subarachnoid hemorrhage?
Spinal tap
101
Major risk factor for Intracerebral hemorrhage?
hypertension
102
Do people lose consciousness with intracerebral hemorrhage.
YES, 50% of the time
103
How do we treat hemorrhagic stroke?
Conservative and supportive. Some patients will benefit from surgical evacuation of the hematoma.
104
Subarachnoid bleeds are due to bleeding from ________ aneurysms.
Saccular
105
Thunderclap headache
Subarachnoid bleed
106
How do we treat a subarachnoid bleed in a conscious patient?
Bed rest, symptomatic and supportive care with cautious reduction in BP
107
What is the most common vascular malformation of the CNS?
arterial venous malformation
108
If the superior division of the MCA is occluded will you have Wernicke's or Broca's aphasia?
Broca's
inferior occlusion is Wernicke's
109
Urinary incontinence, primitive reflexes, and leg weakness is associated with what kind of stroke?
Anterior Cerebral Artery
110
If only of the vertebral arteries is occluded will a patient be symptomatic?
No -- not if the circle of willis is intact
111
Pinpoint pupils and flaccid quadriplegia should make you think of?
total occlusion of both vertebral arteries
