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AANP Leik and Fitzgerald > Neuro > Flashcards

Neuro Flashcards

1
Q

Symptoms of chronic subdural hematoma

A

hx of head trauma (falls, accidents) with headache and gradual cognitive change (apathy, somnolence, confusion)

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2
Q

risk factors for chronic SDH?

A
  • ETOH
  • age (elderly)
  • on anticoagulants and ASA
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3
Q

What is Lhermitte sign?

What disease does it occur in?

A

Lhermitte sign: bending neck forward/flexion causes electric shock-like sensation down back

MS
-can also occur in other conditions eg transverse myelitis, behcet’s, B12 deficiency, spinal cord compression etc

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4
Q

gag reflex is tested with which cranial nerve(s)?

A

CN IX and X - glossopharyngeal and vagus

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5
Q

which sensory test is the first to be abnormal in early peripheral neuropathy?

(vibration, sharp-dull touch, temperature, stereognosis, graphesthesia)

A

vibration

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6
Q

Shingles of CN ______ can result in corneal blindness

A

CN V (trigeminal)

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7
Q

How is mild TBI defined on GCS?

A

defined as GCS 13-15 measured 30 min after injury

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8
Q

Meningitis

triad of classic symptoms?

A

fever
altered mentation
nuchal rigidity

“FAN”

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9
Q

Acute bacterial meningitis

What is seen on CSF findings?

A
  • elevated WBC
  • low glucose
  • elevated protein
  • bacteria isolated from CSF
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10
Q

Acute bacterial meningitis

What patients should have CT head done BEFORE LP?

A

-if at risk for cerebral herniation

Papilledema
focal neurologic deficit
abnormal LOC
new onset seizures (within 1 week)
hx of CNS disease
immunocompromised (HIV, solid organ/BMT, immunosuppressed)
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11
Q

What 2 organisms are responsible for majority of bacterial meningitis (community acquired)?

A

S. pneumoniae followed by N. meningitidis

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12
Q

bacterial meningitis

what needs to be done for close contacts to invasive meningococcal disease?

A

need chemoprophylaxis:

  • rifampin
  • ceftriaxone

within 24 hours up to 10 days after last contact

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13
Q

What are some non-pharm measures to prevent migraine headaches?

what foods are triggers?

A

Avoid precipitating foods/meds
• MSG, chocolate, nitrates (hot dogs, lunch meats, sausage), red wine, beer, caffeine
Stress management
Sleep
Odour triggers: smoke, perfumes
Visual triggers: strobe lights, sunlight, glares

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14
Q

What are contraindications to prescribing triptans?

A

CONTRAINDICATIONS TO VASOCONSTRICTING DRUGS
• Suspected or known CVD (angina, MI, PAD)
• Suspected or known CVA and/or TIAs
• Hyperlipidemia, males > 40, menopausal females
• Uncontrolled HTN
• complex migraines

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15
Q

Common side effects of triptans?

A

flushing, tingling, chest/neck/sinus/jaw discomfort

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16
Q

Triptan use should be limited to _____ days/month to reduce risk of medication overuse headache

A

10

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17
Q

watch for serotonin syndrome when triptans are combined with ________

A

SSRI/SNRI

MAOI

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18
Q

Symptoms of migraine with brainstem aura?

A

• Rare subset of migraine with aura
• Looks like stroke without hemiplegia
• Aura symptoms: unilateral/bilateral visual disturbance, vertigo, ataxia, dysarthria, bilateral tingling, numbness of face
• Throbbing occipital headache and nausea
25% will have LOC lasting 2-30 min

NO MOTOR symptoms

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19
Q

what medication is part of management of giant cell arteritis?

A

high dose prednisone 40-60 mg by mouth daily for weeks

20
Q

amaurosis fugax (transient monocular loss of vision) is associated with _______

A

giant cell arteritis

21
Q

signs and symptoms of polymyalgia rheumatica

A

• Aching and morning stiffness last >30 min, worse with exertion, may be severe
○ “gel phenomenon” - severe morning stiffness that can last until afternoon, stiffness with inactivity
• Neck, shoulder girdle, hip girdle
• At least 1 month

Age 50+, peak age 70-79, F>M

22
Q

what is the treatment approach for cluster headaches?

A

O2: 12 L/min via NRB x 15 min do not use if COPD

triptan (usually sumatriptan 6 mg sc)

23
Q

what medications are used as prophylaxis for cluster headaches?

A

verapamil (calcium channel blocker) if frequent attacks
*avoid grapefruit juice, ECG if dose >400 mg

prednisone (high dose with taper) if infrequent attacks

24
Q

how long do cluster headaches last for?

A

15 min to 3 hours

25
Q

what is the workup for cluster headaches?

A

MRI with contrast for all suspected cluster headaches

26
Q

what medication is used as prophylaxis for tension type headaches?

A

TCA (eg amitriptyline)

second line: mirtazapine, venlafaxine

27
Q

what is the most common type of headache?

A

tension type

28
Q

what is the definition of medication overuse headache? (frequency of headaches and time period)

A

Headaches occurs >15 x /month due to overuse of HA rx for >3 months

29
Q

Medication overuse headaches

What is the definition of overuse?

A

Regular intake for 10+ days/month for >3 months of ergotamines, triptans, opioids, or combo drugs

Regular intake for 15+ days/month for >3 months of simple analgesics (tylenol, ASA, NSAID)

30
Q

Medication overuse headaches

What is the goal limit for use of analgesics?

A
  • OTC or triptans: 9 or less days/month
  • NSAIDs: 14 or less days/month
  • Butalbital: 3 or less days/month
31
Q

TIA

ABCD2 score - what does each stand for?

A 
age (>60)
blood pressure (SBP >140, DBP >90)
clinical features
duration of symptoms (under or over an hour)
diabetes

If score 3+ –> refer to ED for hospitalization

32
Q

target BP control for TIA?

bonus! what antihypertensive class is recommended?

A

• Target BP <140/90 in most
○ <130/80 in diabetic or lacunar strokes or hx ICH

ACE-I and thiazide

33
Q

what is the duration of symptoms to meet definition for TIA?

A

TIMING has been removed as part of definition of TIA
-can have permanent injury with TIA

however ABCDD score use 10-59 min and 60+ min to stratify risk

34
Q

what does FAST stand for?

A
  • face drooping
  • arm weakness
  • speech difficulty
  • time to call 911
35
Q

what is preferred imaging for TIA/CVA?

A

diffusion-weighted MRI

within 24 hours

36
Q

which blood vessel is most commonly affected by ischemic strokes?

A

middle cerebral artery

37
Q

what is the time frame for giving alteplase for ischemic stroke?

A

4.5 hours

38
Q

what is the difference between Broca’s aphasia and Wernicke’s aphasia?

A

Broca’s aphasia: expressive aphasia (<4 words) - difficulty with speech but can read ok

Wernicke’s aphasia: receptive aphasia - difficulties with comprehensive but can speak ok

39
Q

RISK FACTORS for carpal tunnel?

A
  • pregnancy
  • repetitive motions
  • DM
  • RA
  • obesity
  • hypothyroidism
40
Q

What are the three special tests for carpal tunnel?

A

Positive = reproduction of symptoms with….

Tinel’s: percussion
Phalen: reverse prayer x 1 min
Durkan’s: manual compression x 30 sec

41
Q

What diagnostic test should be done for suspected Bell’s palsy?

A

Lyme disease if in endemic area

Facial nerve palsy is an acute neurologic manifestation and the most common cranial neuropathy associated with Lyme disease. Facial nerve palsy due to Lyme disease may be bilateral and may occur with or without meningitis. Additional findings suggestive of possible Lyme disease include erythema migrans, fatigue, headache, arthralgias, and lymphadenopathy

42
Q

migraine with aura

how long do auras last for?

A

max 1 hour
*if longer than one hour then consider alternate diagnosis

At least three of the following six characteristics:
•At least one aura symptom spreads gradually over ≥5 minutes
•Two or more symptoms occur in succession
•Each individual aura symptom lasts 5 to 60 minutes
•At least one aura symptom is unilateral
•At least one aura symptom is positive
•The aura is accompanied, or followed within 60 minutes, by headache

43
Q

is it more common to have migraines with or without aura?

A

migraine without aura (80%)

44
Q

herpes ophthalmicus

affects which cranial nerve?

A

CN V

45
Q

Ramsay Hunt syndrome affects which cranial nerve?

A

CN VIII

AANP Leik and Fitzgerald (14 decks)

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