NEURO Flashcards

1
Q

What is the most common form of dementia?

A

Alzheimer’s

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2
Q

What form of dementia has a slow/gradual onset, over 8-10 years?

A

Alzheimer’s

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3
Q

If a patient is having difficulties with memory, they can’t seem to learn new info but their motor and sensory function is spared – what disorder?

A

Alzheimer’s

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4
Q

What form of dementia has gradual onset, but also involves hallucinations, visuospatial fluctuations along with Parkinsonism?

A

Lewy Body dementia

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5
Q

If a patient is having difficulties with language and executive functioning – what disorder?

A

Frontotemporal dementia

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6
Q

If on MRI a pt has cortical & subcortical changes with sudden almost stepwise changes in function – what disorder?

A

Vascular dementia

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7
Q

What should be done on PE in a pt with dementia?

A

neuro exam, mental status, functional status (SLUMS, mini-cog, MMSE)

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8
Q

What type of labs should we order in a pt we suspect dementia?

A
CBC
Na
BUN/Cr
Fasting Glucose
RPR
TSH
B12
Possible UA
folic acid
and liver function
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9
Q

In a pt we suspect dementia, when would we consider imaging?

A

onset <65; focal sxs; concern from hydrocephalus; recent fall or head trauma

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10
Q

What are some non-pharm options for tx dementia?

A

cognitive rehab
therapy
physical & mental activity
attention to safety

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11
Q

What is being broken down too quickly with dementia?

A

Acetylcholine

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12
Q

What medications slow the breakdown of acetylcholine and are prescribed for dementia? Give some examples

A

Cholinesterase inhibitors

Ex: Donepezil or memantine

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13
Q

What should you always keep on your DDx in a patient you’re concerned has dementia, and thus we may treat them for this as well?

A

Depression

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14
Q

Parkinson’s disease is a disease involving what NT?

A

Dopamine

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15
Q

What are some of the hallmark sxs of Parkinsons? (5)

A
  • Tremor = worse at REST – pill rolling
  • Bradykinesia = slowness of voluntary movements (lack of swinging arms, slow speech)
  • Rigidity = Cogwheel (normal DTRs)
  • Fixed Face
  • *Festination Gait = turn “en bloc”
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16
Q

At what point do we start to treat Parkinson’s?

A

When sxs interfere with function

17
Q

With what meds can we treat Parkinson’s?

A
  • Dopamine reuptake inhibitors = Amantadine
  • Dopamine = Levodopa
    * Start low and titrate up
18
Q

If a pt is presenting with acute changes in mental status – what should you always think of first?

A

MEDICATIONS

19
Q

What 3 meds a classic for causing acute changes in mental status?

A

anticholinergics, prednisone, benzo’s

20
Q

Besides medications, what other things may we need to change in order to help with mental status changes?

A
sleep deprivation
immobility
visual/hearing impairment
INFECTION
DEHYDRATION
21
Q

What are some of the risk factors to a stroke?

A
HTN!! (MOST POWERFUL RF)
Smoking*
atherosclerosis elsewhere
DM*
AFib

Other: male, ETOH, hyperlipidemia, AIDS, previous stroke

22
Q

A lacunar infarct is occurring where? What type of sxs are associated with these?

A

SMALL VESSEL Disease

May be without findings – incidental on CT

23
Q

A cerebral emboli stroke is what?

A

Embolism from heart or artery breaks off and occludes a distant vessel à in the brain

24
Q

What type of stroke is often associated with Afib and is the reason why it’s so important to anticoagulate pt’s with afib?

A

Cardioembolism

25
What artery is affected when a pt has contralateral hemiplegia (hemiparalysis) after a stroke?
Middle Cerebral Artery
26
What artery is most commonly occluded during a stroke?
Middle Cerebral Artery
27
If this artery is occluded during a stroke it can lead to loss of several reflexes (grasp, suck), paralysis of foot/leg, urinary incontinence, and behavioral changes.
Anterior Cerebral Artery
28
If an occlusion occurs in this area of the brain it will results in visual deficits and changes in pupils/sensations?
Posterior Circulation
29
If a pt has transient monocular blindness – what does that mean, what is it called?
Embolism of ophthalmic artery Amaurosis Fugax
30
If it is an acute stroke, what imaging do you need? What are you ruling out?
CT scan | R/O Hemorrhage
31
After a CT scan what’s the next imaging needed? What’s technically the gold standard?
MRI | Gold Standard = Arteriography
32
During an acute stroke what do we do if their BP is 180/90?
LEAVE IT – avoid rapid BP reduction
33
During an acute stroke what do we do if their BP is 203/100?
Okay now you need to lower it – SLOWLY!
34
So, how do we treat an acute stroke?
Once hemorrhage has been ruled out… | <3 hours = TPA + full anticoagulation
35
What are contraindications to TPA?
- Previous stroke or recent bleeding/major surgery - BP >185/110 - Neoplasm - Glucose <50 & platelets <100,000 - Heparin use within 48 hours
36
What’s the difference between a stroke & TIA?
``` Stroke = sxs >24 hours, irreversible damage TIA = sxs <24 hours, reversible ```
37
What surgical treatment is available for a TIA?
carotid endarterectomy or carotid angioplasty/stenting
38
What pharm Tx is available for TIA? When do we initiate it?
ASA If Pt is a poor operative candidate, <70% stenosis