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Sam: Neurology > LAST CLIN MED CARDS MUTHA TRUCKA > Flashcards

LAST CLIN MED CARDS MUTHA TRUCKA Flashcards

1
Q

What is defined as an acute confusional state with decreased attention?

A

Delirium

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2
Q

What is a key feature of patients with delirium on physical exam?

A

Decreased attention

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3
Q

How is delirium diagnosed?

A

Clinical diagnosis

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4
Q

What are some medications that put people at risk for delirium?

A

Anti-cholinergics, sedatives/narcotics/benzodiazpines

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5
Q

What does “sundowning” refer to?

A

Older people whose delirium symptoms get worse at night.

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6
Q

How days after alcohol cessation do withdrawal symptoms peak?

A

2-3 days

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7
Q

What does delirium tremens refer to?

A

Acute alcohol withdrawal syndrome

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8
Q

How do we treat DT’s?

A

Benzodiazepines

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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

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10
Q

What are some symptoms of dementia?

A

Depression, agitation, delusions, insomnia, disinhibition

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11
Q

What is the greatest risk factor for dementia?

A

AGE

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12
Q

Viral cause of dementia?

A

Cruetzfeldt-Jakob

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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.

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14
Q

What type of dementia is most common?

A

Alzheimer’s

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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

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16
Q

People with this disease have a higher incidence of getting Alzheimer’s

A

Down Syndrome

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17
Q

Does vascular dementia have an insidious or sudden onset?

A

Sudden

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18
Q

What is an example of frontotemporal dementia?

A

Huntington’s

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19
Q

Pick’s disease affects what part of the brain?

A

Anterior frontal and temporal cerebral cortex

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20
Q

What kind of dementia has visual hallucinations and parkinson’s features?

A

Dementia with Lewy bodies

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21
Q

What drugs do we use to treat dementia with lewy bodies?

A

Anticholinergic drugs

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22
Q

I have gait ataxia, dementia, and urinary incontinence. On imaging, you see large ventricles. What do I have?

A

Normal Pressure Hydrocephalus

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23
Q

How do we treat Normal Pressure Hydrocephalus?

A

Shunt

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24
Q

Wernicke’s encephalopathy may be due to deficiency of what?

A

Thiamine

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25
Q

What syndrome explains the inability to recall recent memory despite immediate memory retention?

A

Korsakoff’s syndrome

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26
Q

What does “punch drunk” refer to?

A

Dementia pugilistica – boxers get this.

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27
Q

What is transient global amnesia?

A

When you’re awake and fine and then later forget a moment of time.

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28
Q

According to the American Academy of Neurology, what labs should you get when working up dementia?

A

B12 and thyroid

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29
Q

If we are suspecting dementia, should we get imaging?

A

Yeah, CT or MRI should be considered

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30
Q

What is the most common cause of orthostatic hypotension?

A

Dehydration

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31
Q

What is the physiology behind orthostatic hypotension?

A

With aging, we lose the ability to vasoconstrict — blood falls to feet and pools, we get dizzy and/or pass out

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32
Q

To say that someone has orthostatic hypotension, by definition, how much do numbers need to drop?

A

Fall in systolic BP by 20

Fall in diastolic BP by 10

Increase in heart rate 10-25 bpm

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33
Q

Young athlete passes out, what should be on your DDx?

A

Hypertrophic cardiomyopathy

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34
Q

What is the best treatment for true cardiac syncope?

A

Cardiac defibrillator

Also, cardio get out of neuro. I don’t have time for you.

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35
Q

How will a nystagmus differ between a central and peripheral lesion?

A

Central lesion – vertical nystagmus

Peripheral lesion – horizontal nystagmus

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36
Q

If you look at someone’s nystagmus and it beats 2-3 times, should you be concerned?

A

No. 2-3 is normal.

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37
Q

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.

A

Nystagmus – AWAY

fall on their face – TOWARD

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38
Q

Triad of Meniere’s?

A
  1. low frequency hearing loss
  2. tinnitus
  3. vertigo
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39
Q

How do we treat Meniere’s?

A
  1. Diuretics – HCTZ

2. Low salt diet,

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40
Q

I say unilateral hearing loss, you say?

A

Acoustic neuroma

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41
Q

How do we diagnose an acoustic neuroma?

A

MRI

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42
Q

What test do we perform to test for BBPV?

A

Dix-hallpike maneuver

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43
Q

What maneuver do we do to treat BBPV?

A

Epley maneuver

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44
Q

Convinced a patient has orthostatic hypotension, but their BP doesn’t show it when you test for it. What other test could you perform?

A

Tilt table test

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45
Q

What percentage of the population will experience a seizure in their lifetime?

A

5-10%

46
Q

What type of seizure is described as a deranged area of cerebral cortex often due to a structural anomaly. Consciousness is preserved.

A

Partial

47
Q

What type of seizure is described as “diffuse region of the brain firing simultaneously”?

A

General

48
Q

These types of seizures may be motor, sensory, autonomic, psychic but without loss of consciousness.

A

Simple partial seizure

49
Q

What type of seizure begins distally, and spreads proximally?

A

Jacksonian March

50
Q

What is Todd’s paralysis?

A

Local paresis lasting minutes to hours.

51
Q

What type of seizure may continue for hours to days?

A

Epilepsia partialis continua

52
Q

Tell me about the process of a complex partial seizure.

A

Often begins with an aura

Followed by ictal stage –> chewing, picking

Post ictal confusion

53
Q

If you have a partial seizure with secondary generalization, what part of the brain is this most likely occurring in?

A

Frontal lobe

54
Q

Are absence seizures partial or generalized?

A

General

55
Q

Absence seizures:

  1. Do you lose consciousness?
  2. Do you experience post-ictal confusion?
A
  1. you DO lose consciousness

2. you DO NOT experience post-ictal confusion

56
Q

What age to absence seizures start?

A

4-8 y/o or early adolescence

57
Q

What is the difference between an absence seizure and an atypical absence seizure?

A

symptoms last longer, more motor features

58
Q

What percentage of patient with epilepsy experience grand mal seizures?

A

10%

59
Q

When is a seizure is due to metabolic derangement, what type of seizure will it most likely be?

A

Grand mal

60
Q

What will the tonic phase look like on EEG?

A

Increased low voltage and high amplitude

61
Q

What will the clonic phase look like on EEG?

A

spike and wave activity develops

62
Q

What type of seizure will show hippocampal sclerosis?

A

Mesial Temporal Lobe Epilepsy

63
Q

50% of new onset seizures in adults is caused by?

A

cerebrovascular disease

64
Q

Drugs that increase GABA function?

A

Benzodiazepines, phenobarbitol

65
Q

What drug is good for partial seizures, post herpetic neuralgia, and neuropathic pain?

A

Gabapentin

66
Q

When might we consider stopping seizure meds?

A

If the patient is low risk, has one seizure and is then seizure free, normal exam, and normal EEG.

67
Q

What is the name for a continuous seizure?

A

Status elipticus

68
Q

Intrancranial vasoconstriction is responsible for?

A

causing the migraine “aura”

69
Q

headache results from _______ _________ and distension of cranial nerves (external carotid) with activation of perivascular pain fibers.

A

rebound vasodilation

70
Q

What are some migraine triggers?

A

Sex, emotional stress, lack of sleep, foods, odors, missed meals, menstruation

71
Q

What does expanding scotoma and scintillating margin refer to?

A

Expanding scotoma: blindspot

Scintillating margin: visual hallucinatins

72
Q

How do we explain a complex migraine?

A

Prolonged aura with neurologic deficits lasting 1 hour up to a week.

73
Q

What are three big things that tryptans do?

A
  1. Turn off release of serotonin
  2. Vasoconstrict
  3. Turn off activation of CNS
74
Q

If your patient is experiencing a severe headache, what is the best way to administer medication?

A

Injection -

75
Q

What is the most common type of headache?

A

Tension

76
Q

What type of headache is described as intense unilateral, orbital, supraorbital, or temporal head pain?

A

Cluster headache

77
Q

Effective treatment for cluster headaches?

A

100% oxygen for 15 minutes

78
Q

What drug do we use for PPx treatment of cluster headaches?

A

CCB! Verapamil

79
Q

Most common cause of chronic daily headache?

A

Medication overuse – polypharmacy.

PA school in my opinion.

80
Q

Which intracranial mass lesion has the worst prognosis?

A

Gliomas

81
Q

Why has the incidence of stroke decreased?

A

Better control of HTN

82
Q

What is the most common cause of death in patients with cerebrovascular disease?

A

Myocardial infarction

83
Q

Number one risk factor for stroke?

A

Hypertension

84
Q

50% of all ischemic strokes is caused by?

A

Atherosclerosis

85
Q

20% of all ischemic strokes are caused by?

A

A fib

86
Q

Major risk factor for lacunar infarcts?

A

Hypertension

87
Q

Lacunar infarcts will look like what on CT?

A

punched out lesions

88
Q

A single embolus for a cardiac source will likely require full ________ for life.

A

anti-coagulation

89
Q

Do strokes typically present with warning symptoms?

A

No

90
Q

if you experience a middle cerebral artery stroke on the dominant side of your brain, what symptom are you likely to have?

A

Aphasia

91
Q

if you experience a middle cerebral artery stroke on the non-dominant side of your brain, what symptoms are you likely to have?

A

Anosognosia (denial/neglect of deficit)

Speech and comprehension preserved

92
Q

What is amaurosis fugax?

A

fleeting blindness

93
Q

If i’m experiencing leg weakness and gait disturbance, where is my stroke most likely to be?

A

Anterior cerebral artery

94
Q

True or False

We are really concerned about controlling BP when people present with stroke symptoms.

A

False. unless over 200 systolic and 100 diastolic.

the brain will auto-regulate

95
Q

What is a screening tool for evaluating common carotid and origin of internal carotid artery?

A

Carotid doppler ultrasound

96
Q

What is the most accurate test/imaging for evaluating common carotid and origin of internal carotid artery?

A

Arteriography

97
Q

When do we consider a carotid endarterectomy?

A

When they are a good surgical candidate and they have greater than 70% stenosis.

98
Q

How do we treat lacunar infarcts?

A

We treat the shit out of their HTN and hyperlipidemia.

99
Q

What are the indications for full anticoagulation?

A
  1. Embolus from the heart

2. A fib > 72 hours

100
Q

CT scan is usually diagnostic for hemorrhagic stroke, however, what other test might you do to r/o subarachnoid hemorrhage?

A

Spinal tap

101
Q

Major risk factor for Intracerebral hemorrhage?

A

hypertension

102
Q

Do people lose consciousness with intracerebral hemorrhage.

A

YES, 50% of the time

103
Q

How do we treat hemorrhagic stroke?

A

Conservative and supportive. Some patients will benefit from surgical evacuation of the hematoma.

104
Q

Subarachnoid bleeds are due to bleeding from ________ aneurysms.

A

Saccular

105
Q

Thunderclap headache

A

Subarachnoid bleed

106
Q

How do we treat a subarachnoid bleed in a conscious patient?

A

Bed rest, symptomatic and supportive care with cautious reduction in BP

107
Q

What is the most common vascular malformation of the CNS?

A

arterial venous malformation

108
Q

If the superior division of the MCA is occluded will you have Wernicke’s or Broca’s aphasia?

A

Broca’s

inferior occlusion is Wernicke’s

109
Q

Urinary incontinence, primitive reflexes, and leg weakness is associated with what kind of stroke?

A

Anterior Cerebral Artery

110
Q

If only of the vertebral arteries is occluded will a patient be symptomatic?

A

No – not if the circle of willis is intact

111
Q

Pinpoint pupils and flaccid quadriplegia should make you think of?

A

total occlusion of both vertebral arteries

Sam: Neurology (4 decks)

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