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CAM I > Neuro > Flashcards

Neuro Flashcards

1
Q

Alert

A

Normal

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2
Q

Lethargic

A

Loud voice

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3
Q

Obtunded

A

Tactile stimulus

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4
Q

Stuporous

A

Painful stimulus

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5
Q

Comatose

A

No response

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6
Q

Agnosia

A

Unable to process sensory information

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7
Q

Alexia

A

Can’t process words, letters

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8
Q

Prosopagnosia

A

Can’t recognize faces

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9
Q

Asterognosis

A

Does not identify tactile clues (i.e., keys)

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10
Q

Apraxia

A

Inability to perform coordinated purposeful movement

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11
Q

GCS- eye opening

A

1- none
2- to pain
3- to voice
4- spontaneous

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12
Q

GCS- verbal

A 
T- intubated
1- none
2- sounds
3- nonsense
4- confused
5- nl
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13
Q

GCS- motor

A 
1- none
2- decerebrate
3- decorticate
4- pain
5- purposeful
6- command
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14
Q

Motor exam

A

0- no muscular contraction detected
1- A barely detectable flicker or trace of contraction
2- Active movement of the body part with gravity eliminated
3- Active movement against gravity
4- Active movement against gravity and some resistance
5- Active movement against resistance without evident fatigue; this is nl muscle strength

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15
Q

DTR grading

A

0- no response, absent
1+ - Somewhat diminished, low nl
2+ - Average, expect response; nl
3+ - Brisker than average, slightly hyperreflexic
4+ - Very brisk, hyperactive, with clonus

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16
Q

Bicep spinal level

A

C5

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17
Q

Brachioradialis spinal level

A

C6

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18
Q

Tricep spinal level

A

C7

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19
Q

Patellar spinal level

A

L4

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20
Q

Hamstring spinal level

A

L5

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21
Q

Achilles spinal level

A

S1

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22
Q

Red flags with HA

A 
Sudden onset, or severe persistent HA that reaches maximal intensity within a few seconds or minutes after the onset of pain
First or worst HA of my life
Progressively worsening
Focal neurological sx
Fever
Any change in mental status, personality, or fluctuation in LOC
Concomitant infection
Rapid onset with strenuous exercise
New HA in
-CA pts: metastasis to brain
-HIV- encephalitis or meningitis
-Lyme titer
-Age <5 or > 50
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23
Q

Temporal arteritis

A

Inflammation of temporal artery in scalp
Can lead to CVA
Dx by bx of artery
Treat with glucocorticoids, antiplatelet therapy

24
Q

Abnormalities of the temporal artery

A

Diminished pulse
Swelling
Tenderness

25
Q

Chronic nasal stuffiness or chronic respiratory

A

Consider sinusitis

26
Q

Impaired vision or seeing halos

A

Consider glaucoma

27
Q

Visual field defects

A

Consider lesion of the optic pathway

28
Q

Blurring of vision on forward bending of the head, HAs upon waking early in the morning that improve with sitting up, and double vision or loss of coordination and balance

A

Consider increased ICP

29
Q

HA that is relieved with recumbency and exacerbated with upright posture

A

Consider the diagnosis of low CSF pressure HA

30
Q

Sudden, severe, unilateral vision loss

A

Consider optic neuritis

31
Q

HA, fatigue, generalized aches and pain, and night sweats in 55 yoa or older

A

Consider temporal arteritis

32
Q

Preventative migraine tx

A 
More than 2-3 x/mo
Avoid triggers
Anticonvulsants (valproic acid)
Beta blockers (propranolol)
TCA (amitriptyline)
Ca channel blockers (verapamil)
Botox: 31 injections every 3 months
33
Q

Abortive/rescue migraine tx

A

Triptans
NSAIDs
Anti-emetics
Opiates

34
Q

When should triptans be avoided?

A

Hemiplegic or basilar migraine
Pts with risk factors for CVA
HTN
Women who are pregnant

35
Q

Cluster HA acute tx

A 
Oxygen inhalation (100% oxygen 12-15L/min for 15 min NRB)
Sumatriptan or zolmitriptan nasal sprays
36
Q

Prophylactic cluster HA tx

A 
Lithium
Verapamil
Topiramate
Prednisone
Occipital nerve stimulation
37
Q

Examples of peripheral vertigo

A

BPPV
Vestibular neuronitis/labyrinthitis
Meniere’s disease

38
Q

Accompaniments to vertigo

A

Nystagmus
Postural instability
Sx of ear involvement (hearing loss) are suggestive of a peripheral cause of vertigo
Additional neuro signs strongly suggest the presence of a central vestibular lesion

39
Q

BPPV

A

Characterized by recurrent vertigo (lasting a few mins per occurrence) associated with changes in head position

40
Q

Vestibular neuronitis

A

Viral or postviral inflammatory disorder affecting the vestibular portion of the eighth cranial nerve
Characterized by rapid onset of severe vertigo with n/v, gait instability
Benign disorder, self-limited, and associated with a complete recovery in most pts
Several days of intense vertigo
Unsteadiness for weeks to months

41
Q

Workup for vestibular neuronitis

A

MRI/MRA to r/o alternative diagnoses

42
Q

Tx for vestibular neuronitis

A 
Disease-specific tx with corticosteroids, antiviral agents, symptomatic txs and vestibular rehab
Symptomatic tx
-Antiemetic
-Antihistamine
-Benzos
43
Q

Meniere’s disease

A 
Recurrent vertigo
Progressive hearing loss
Tinnitus
Aural fullness
N/V during vertigo episodes
Typically between 20-40 yoa
Clinical dx
44
Q

Ataxia

A

Caused by lesions to the cerebellum
Disordered contractions of agonist and antagonist muscles, and lack of nl coordination between movements at different joints
Continuous overshooting, overcorrecting and then overshooting again around the intended trajectory

45
Q

Dysrhythmia

A

Abnormal timing of movements

46
Q

Dysmetria

A

Abnormal trajectories through space
Abnormal overshoot
Abnormal undershoot

47
Q

Bradykinesia

A

Slowed movement

48
Q

Hypokinesia

A

Decreased amount of movements

49
Q

Akinesia

A

Absence of movement

50
Q

Tx of postural tremor

A

Propranolol

51
Q

Tx of Parkinson’s

A

Levadopa last line; can also add carbidopa
Dopaminergic agents (Bromocriptine, Pramiprexole, Ropinirole)
Amantadine
Anticholincergics (Benztropine, Trihexyphenidyl)
MAO-B inhibitors (Selegiline, Rasigiline)
COMT inhibitors to add to Levadopa

52
Q

Workup for Huntington’s

A

CT, MRI shows progressive atrophy of striatum, esp caudate nucleus
CAG gene mapping- most sensitive and specific

53
Q

Tx for Huntington’s

A

Chorea dominant: Antidopaminergic agents (Phenothiazines, Haloperidol) and Benzos
Tetrabenzine for dyskinesia
Amantadine may help with chorea

54
Q

Workup for Alzheimers

A 
TSH
B12
CBC
Electrolytes
UA
CT/MRI
55
Q

Tx for Alzheimers

A 
Cholinesterase inhibitors:
-Aricept (donepezil)
-Exelon (rivastigmine)
-Razadyne (galantamine)
Memantine

CAM I (5 decks)

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