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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
Chronic nasal stuffiness or chronic respiratory
Consider sinusitis
26
Impaired vision or seeing halos
Consider glaucoma
27
Visual field defects
Consider lesion of the optic pathway
28
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
Consider increased ICP
29
HA that is relieved with recumbency and exacerbated with upright posture
Consider the diagnosis of low CSF pressure HA
30
Sudden, severe, unilateral vision loss
Consider optic neuritis
31
HA, fatigue, generalized aches and pain, and night sweats in 55 yoa or older
Consider temporal arteritis
32
Preventative migraine tx
``` 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
Abortive/rescue migraine tx
Triptans NSAIDs Anti-emetics Opiates
34
When should triptans be avoided?
Hemiplegic or basilar migraine Pts with risk factors for CVA HTN Women who are pregnant
35
Cluster HA acute tx
``` Oxygen inhalation (100% oxygen 12-15L/min for 15 min NRB) Sumatriptan or zolmitriptan nasal sprays ```
36
Prophylactic cluster HA tx
``` Lithium Verapamil Topiramate Prednisone Occipital nerve stimulation ```
37
Examples of peripheral vertigo
BPPV Vestibular neuronitis/labyrinthitis Meniere's disease
38
Accompaniments to vertigo
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
BPPV
Characterized by recurrent vertigo (lasting a few mins per occurrence) associated with changes in head position
40
Vestibular neuronitis
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
Workup for vestibular neuronitis
MRI/MRA to r/o alternative diagnoses
42
Tx for vestibular neuronitis
``` Disease-specific tx with corticosteroids, antiviral agents, symptomatic txs and vestibular rehab Symptomatic tx -Antiemetic -Antihistamine -Benzos ```
43
Meniere's disease
``` Recurrent vertigo Progressive hearing loss Tinnitus Aural fullness N/V during vertigo episodes Typically between 20-40 yoa Clinical dx ```
44
Ataxia
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
Dysrhythmia
Abnormal timing of movements
46
Dysmetria
Abnormal trajectories through space Abnormal overshoot Abnormal undershoot
47
Bradykinesia
Slowed movement
48
Hypokinesia
Decreased amount of movements
49
Akinesia
Absence of movement
50
Tx of postural tremor
Propranolol
51
Tx of Parkinson's
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
Workup for Huntington's
CT, MRI shows progressive atrophy of striatum, esp caudate nucleus CAG gene mapping- most sensitive and specific
53
Tx for Huntington's
Chorea dominant: Antidopaminergic agents (Phenothiazines, Haloperidol) and Benzos Tetrabenzine for dyskinesia Amantadine may help with chorea
54
Workup for Alzheimers
``` TSH B12 CBC Electrolytes UA CT/MRI ```
55
Tx for Alzheimers
``` Cholinesterase inhibitors: -Aricept (donepezil) -Exelon (rivastigmine) -Razadyne (galantamine) Memantine ```

CAM I (5 decks)

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