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Neurology > MKSAP > Flashcards

MKSAP Flashcards

1
Q

Name 3 Headache Red Flags

A 
First or Worst 
Abrupt or Thunderclap Headache 
Change in Headache Pattern 
Neurologic Symptoms/Deficits > 1 hour 
New Headache

Suspect secondary causes in patients > 50 yo, immunocompromised patients, triggered by exertion, sexual activity or valsalva maneuver

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2
Q

What causes the Thunderclap Headache?

or the worse headache of my life

A

Subarachnoid Hemorrhage due to rupture of sacular aneurysm

Xanthochromia in CSF

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3
Q

What size and location of a cerebral aneurysm has the highest risk of rupture?

A

> 5 mm and posterior circulation

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4
Q

How long do you treat central vein thrombosis or dural sinus thrombosis?

A

3-6 months of antiocoagulation

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5
Q

What is reversible cerebral vasoconstriction syndrome?

A

transient failure of cerebrobascular autoregulation with trigger to adnergic/serotonergic drugs, triggered by exertion, valsalva, or abrupt head movement
Angiography showing multifocal areas of cerebral vasoconstriction
Tx: control BP with Nimodipine/Verapamil

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6
Q

What is posterior reversible encephalopathy syndrome?

Sx, Dx

A

cerebrovascular regulation disorder
Sx: HA, N/V, change MS, seizure, visual changes
MRI: white matter edema in posterior brain (posterior occipital or parietal lobe)

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7
Q

Name 5 risk factors of Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

A

Female, Obese, child-bearing age, Vitamin A toxicity, use of tetracycline Abx, Isoretinoin, pregnancy, steroid use

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8
Q

Diagnose Idiopathic Intracranial Hypertension

A
  1. Papilledema
  2. Visual Field Obscuration (increased blind spot and decreased peripheral field)
  3. MRI showing normal/small ventricles, partially empty sella turcica, flattened optic globe
  4. CSF opening pressure > 250
    (You can do an LP because of cerebral compliance- no risk of herniation with increased ICP- Ani)
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9
Q

Treat Idiopathic Intracranial Hypertension

A

Acetazolamide
or Topiramate (for carbonic anhydrase inhibitor)
If refractory, CSF decompression by optic nerve fenestration or Lumboperitoneal shunting

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10
Q

Treat Intracranial Hypotension

improving symptoms while supine

A

Iatrogenic- LP, surgery or trauma
bedrest, analgesia, fluids, 10-15mL homologous blood in epidural space, IV caffeine, epidural saline, surgically correct dural tear

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11
Q

Treat Trigeminal Neuralgia

What blood tests do you need to monitor with medication?

A

Carbamazepine or Oxcarbamazepine (check for agranulocytosis or hyponatremia)
2nd line: Gabapentin, baclofen, lamotrigine, clonazepam

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12
Q

Diagnostic Criteria for MIGRAINE

A 
Onset: 5 attacks lasting 4-72 hours 
Must have 2/4: 
1. Unilateral
2. Pulsatile 
3. Severe, Debilitating 
4. Aggravated by exertion

Must have 1/2:

  1. Nausea/Vomiting
  2. Photophobia/Phonophobia
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13
Q

In which type of migraines should you AVOID triptans?

A

Brainstem aura and hemiplegic (motor weakness)

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14
Q

Why should you avoid OCP in Migraine with auras?

A

Increased risk of STROKE

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15
Q

First line therapy for Migraines

A

NSAIDS, triptans

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16
Q

Treat Status Migrainosus

A

IV dihydroergotamine

17
Q

Treat Chronic Migraine

A

Topiramate or botulinum toxin A

18
Q

Treat Refractory Migraine

A

Prochlorperazine (antidopaminergic)

19
Q

Prevent Migraines

A 
Valproic Acid 
Metoprolol 
Propranolol 
Timolol 
Topiramate 
Divalproex sodium/ Depakote
20
Q

Diagnostic Criteria for Tension Type Headache

A 
10 attacks lasting 30 minutes-7 days 
Must have 2/4: 
1. Bilateral
2. Non pulsatile 
3. Mild-moderate Intensity (Not Ridic Severe) 
4. Not aggravated by exertion

Must have 1/2:

  1. No nausea/vomiting
  2. No more than 1 episode of photophobia/phonophobia

ITS NOT A MIGRAINE HA!

21
Q

First line Therapy for Tension Type Headache

A

NSAIDS, Acetaminophen, ASA

22
Q

Prevent Tension Type Headache

A

Amitriptyline
Venlafaxine
Mirtazapine

23
Q

Diagnostic criteria for Cluster Headache

A

5 severe attacks of unilteral orbital, supraorbital or temporal
Lasting 5-180 minutes (NO MORE THAN 3 HOURS)
Must have 1 of the following:
conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating/flushing, miosis, ptosis, eyelid edema)
OR
restlessness/agitation

24
Q

Treat Acute Cluster Headache

A

Subcutaneous Sumatriptan

O2

25
Q

Prevent Cluster Headache

A

VERAPAMIL

after steroid transition

26
Q

Timing & Diagnosis of Chronic Paroxysmal Hemicrania

A

5 times daily from 3-20 minutes

INDOMETHACIN

27
Q

Timing & Diagnosis of SUNCT

Extra Credit: What does SUNCT stand for? =)

A

10-100s times daily from 1 second- 10 minutes
Lamotrigine helps, but nothing definitive

Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing- HAH!

28
Q

What causes Epidural Hematoma?

A

Temporal Bone fracture with middle meningeal artery laceration
LUCID INTERVAL

29
Q

What causes Subdural Hematoma?

A

Bridging Vein between cortex/dura

INDOLENT COURSE

30
Q

Broad spectrum treatment of seizures

for generalized and partial epilepsy

A

Lamotrigine, Levetiracetam, Topiramate, Valproic Acid, Zonisamide

31
Q

Narrow spectrum treatment of seizures

A

Carbamazepine, Oxcarbazepine, gabapentin, pregabalin phenobarbital, phenytoin

32
Q

Which AED to give pregnant patients?

A

Lamotrigine (and folate!!)

33
Q

Which AED cause nephrolithiasis?

A

Topiramate/Zonisamide

34
Q

Which AED causes weight gain, increased cholesterol or PCOS?

A

Valproic Acid

35
Q

Which AED do you need to routinely check levels because it can cause arrhythmias?

A

Phenytoin

36
Q

Which AED is notorious for causing hyponatremia?

A

Carbazepine

37
Q

Which AEDs are safe in the elderly?

A

Lamotrigine (in preggos too!)
Levetiracetam
Gabapentin

38
Q

Estrogen containing contraceptive can lower which AED level?

A

Lamotrigine

Neurology (2 decks)

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