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INTERNAL MED IP/OP > NEURO > Flashcards

NEURO Flashcards

1
Q

A pt with a tremor that occurs when their hand is outstretched or they go to reach for something, but not at rest, is known as what?

A

Essential tremor

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2
Q

What might a pt report with an essential tremor?

A

It is improved with alcohol

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3
Q

How do you treat an essential tremor?

A

Propranolol

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4
Q

What movement disorder is inherited, occurring at a younger age, with choeiform movements?

A

Huntington’s disease

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5
Q

A decrease in dopamine is associated with what movement disorder?

A

Parkinson’s

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6
Q

What are some of the sxs of Parkinson’s?

A

pill rolling (at rest or with intention), bradykinesia (slow movement), cogwheeling, masked facial expression, micrographia, stooped posture, shuffling gait

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7
Q

How do we treat Parkinson’s?

A

Anticholinergics, amantadine for older adults

Levodopa for advanced patients

*Start treatments when function is impaired

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8
Q

What is the most common form of dementia?

A

Alzheimer’s

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9
Q

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

A

Alzheimer’s

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10
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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11
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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12
Q

Lewy body dementia is associated with what portion of the brain?

A

basal ganglia

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13
Q

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

A

Frontotemporal dementia

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14
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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15
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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16
Q

What’s the first question of a MMSE?

A

Orientation – what’s the year, season, month, date, day

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17
Q

What occurs in a mini-cog exam?

A 
Remember/repeat 3 words
 
Draw a clock with hands at a specific time
 
Recall the 3 words
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18
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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19
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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20
Q

What are some non-pharm options for tx dementia?

A

cognitive rehab, therapy, physical & mental activity; attention to safety

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21
Q

What is being broken down too quickly with dementia?

A

Acetylcholine

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22
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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23
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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24
Q

What disorder involves idiopathic demyelinating affecting the white matter of the CNS?

A

MS

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25
Q

Who is affected by MS, and how do we diagnose it?

A

Women and peaks in 20-30’s

Diagnosed by 2 or more clinically distinct episodes of CNS dysfunction separated by space and time
Motor dysfunction, diplopia, gait disturbance, bowel/bladder dysfunction, and sexual dysfunction

(Lhermitte sign = electric shock that runs down the spine and limbs with neck flexion)

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26
Q

How do we confirm diagnosis of MS?

A

clinical + MRI with gad to show cerebral or spinal plaques

LP shows oligoclonal bands

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27
Q

How do we treat MS?

A

Glucocorticoids (acute)

Interferon beta, glatiramer, natalizumab (chronic)

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28
Q

If there is a LOC with a seizure, what is it?

A

Generalized seizure (convulsive or not – absence)

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29
Q

If there is NO LOC with a seizure, what is it?

A

Simple partial seizure (jacksonian seizure)

Complex partial seizure (auras)

30
Q

If a child is staring off into space, with moments of blankness, constant blinking or lip smacking – dx?

A

Absence (petite-mal) seizure

31
Q

What is the temporary paralysis after a seizure known as?

A

Todd’s paralysis

32
Q

How do we work-up a seizure?

A

Labs (CBC, electrolytes, glucose, Ca, Mg, renal function, and tox)

CT or MRI and EEG

33
Q

How do we treat seizures? Who cannot take those medications?

A

carbamazeprine, phenytoin, and Valproate (valproic acid)

*women who are preggo, and those of child bearing age need extra folic acid

34
Q

At what point do we prescribe anticonvulsant medications?

A

DO NOT USE in the setting of a single unprovoked seizure in a pt with a normal neurologic exam

35
Q

How do we treat an absence seizure?

A

Ethosuximide

36
Q

If the CT or MRI after a seizure is negative and no provoking stimuli is found, what dx?

A

Epilepsy

37
Q

For status epilepticus what is the Tx?

A
  1. Lorazepam
  2. Phenytoic (valproic acid)
  3. Phenobarbital (propofol)
38
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

39
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

40
Q

A cerebral emboli stroke is what?

A

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

41
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

42
Q

What artery is affected when a pt has contralateral hemiplegia (hemiparalysis) after a stroke?

A

Middle Cerebral Artery

43
Q

What artery is most commonly occluded during a stroke?

A

Middle Cerebral Artery

44
Q

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.

A

Anterior Cerebral Artery

45
Q

If an occlusion occurs in this area of the brain it will results in visual deficits and changes in pupils/sensations?

A

Posterior Circulation

46
Q

If a pt has transient monocular blindness – what does that mean, what is it called?

A

Embolism of ophthalmic artery - Amaurosis Fugax

47
Q

If it is an acute stroke, what imaging do you need? What are you ruling out?

A

CT scan

R/O Hemorrhage

48
Q

After a CT scan what’s the next imaging needed? What’s technically the gold standard?

A

MRI

Gold Standard = Arteriography

49
Q

During an acute stroke what do we do if their BP is 180/90?

A

LEAVE IT – avoid rapid BP reduction

50
Q

During an acute stroke what do we do if their BP is 203/100?

A

Okay now you need to lower it – SLOWLY!

51
Q

So, how do we treat an acute stroke?

A

Once hemorrhage has been ruled out…

<3 hours = TPA + full anticoagulation

52
Q

What are contraindications to TPA?

A 
Previous stroke or recent bleeding/major surgery
 
BP >185/110
 
Neoplasm
 
Glucose <50 &amp; platelets <100,000
 
Heparin use within 48 hours
53
Q

If the cause of a pts stroke is an embolus from the heart – how do we treat?

A

Full anticoag

54
Q

What’s the difference between a stroke & TIA?

A

Stroke = sxs >24 hours, irreversible damage

TIA = sxs <24 hours, reversible

55
Q

What surgical treatment is available for a TIA?

A

carotid endarterectomy or carotid angioplasty/stenting

56
Q

What pharm Tx is available for TIA? When do we initiate it?

A

ASA

If Pt is a poor operative candidate, <70% stenosis

57
Q

If a pt presents with fever, AMS, a stiff neck, HA, and photophobia – what do you think? What do you do on PE?

A

Meningitis
*Nuchal rigidity – KERNIG (supine, flex the knee, resistance to extend the knee)
BRUDZINSKI (supine, lifting the head causes the hip to flex)

58
Q

In a pt you are concerned has meningitis also has petechial rash what do you think is the cause?

A

N. meningitis

59
Q

How do you work up a pt you are concerned about meningitis?

A

CT

LP

60
Q

If a LP shows WBC over 1,000, increased proteins, and decreased glucose – what do you think?

A

Meningitis

61
Q

What is the MC cause of meningitis

A

Strep pneumo; Neisseria meningitides; HIB; Listeria

62
Q

What type of bacteria would we see in a 50 y/o male with meningitis?

A

Listeria

63
Q

What is the MC cause of meningitis in an infant?

A

Group B strep

64
Q

How do we treat meningitis?

A

Emperically with dexamethasone, ceftriaxone, and vanco

65
Q

What would you give a 50 y/o with meningitis?

A

Ampicillin

66
Q

What can you not use in a child in the first month of life to treat meningitis?

A

Ceftriaxone

GIVE = ampicillin, cefotaxime, +/- genatmycin

67
Q

How do we confirm cure of meningitis?

A

CSF re-test in 24 hours, should be clear

68
Q

What would the CSF look like in viral meningitis?

A 
More lymphs
 
WBC less than 1,000
 
Protein and glucose are normal
69
Q

How do we treat viral meningitis?

A

Supportive (cause is HSV)

70
Q

What disorder causes unilateral facial paralysis where a pt cannot raise the eyebrow? Cause? Tx?

A 
Bell’s Palsy
 
Cause = herpes simplex virus
 
Tx = course of oral prednisone to help with full recoverys, usually self-limiting
71
Q

A pt presents with bilateral distal extremity weakness that ascends up the legs. It is somewhat painful and DTR’s a decreased. – Dx? Cause? Workup?

A 
Guillian- Barre

Campylobacter jejuni
 
EMG and CSF (may see elevated proteins)
72
Q

How do we treat guillian-barre?

A 
Hospitalize pts to watch respiratory status
 
Plasmapheresis ASAP or IVIG
 
Rehab

INTERNAL MED IP/OP (9 decks)

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