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My Clin Med 4 > Neuro > Flashcards

Neuro Flashcards

1
Q

Types of primary headache (3)

A

Migraine
Tension type
Cluster

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2
Q

Typical quality of migraine

A

pulsating, throbbing, lateral,

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3
Q

Typical quality of tension head ache

A

tightness, pressure, band like, worse at end of day

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4
Q

cluster headache quality

A

Ice pick, same time each day or night

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5
Q

Additional symptoms of migraine (4)

A

N/V, photophobia, sound and smell sensitivity

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6
Q

treatment of tension headaches

A

treat anxiety and depression, CBT, relaxation, Massage

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7
Q

Number of migraines to be diagnostic recurrent:
without aura
with aura

A

without aura: 5

with aura: 2

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8
Q

migraine Treatment (non- pharmacologic)

A

avoid precipitating factors,
rest in quiet dark room,
simple ananglesic

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9
Q

Pharm treatment of migraine

A 
Ergotamines - cafergot
Sumatriptan 
prochlorperazine (Compazine)
Reglan or Zofran 
Butalbital - habit forming
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10
Q

migraine preventative therapy - when indicated and what

A

if migraines >2-3 x per month
botulism,
acupuncture, neurostimulation techniques

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11
Q

cluster headache number for diagnosis

A

5 attacks occurring everyother day - 8x / day

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12
Q

prophylactic cluster headaches treatment (3)

A

lithium carbonate
verapamil
topiramate

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13
Q

pseudotumor cerebri symptoms (4)

A

papilledema,
increased ICP,
normal or small ventricle sizes.
Diplopia, blurred vision, transient visual obscuration

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14
Q

Pseudotumor cerebri treatment

A

repeat LP, Acetazolamide
thiazide diuretics,
steroids

Severe: lumbar peritoneal shunting, optic nerve sheath decompression

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15
Q

Post herpetic neuralgia treatment

A

anticonvulsants, gabapentin, antispasmodic agents,

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16
Q

Myasthenia gravis Signs and symptoms

A

extra ocular muscle and skeletal muscles weakness and fatigability d/t decrease in Ach receptors in neuro muscular junction
exacerbations and remissions (non-complete)
non-symmetric proximal muscle weakness

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17
Q

Myasthenia Gravis treatment

A

acetylcholine esterase inhibitor (pyridostygmine) –>
prednisolone and azathioprine –>
mycophenolate mofetil –>
other immune suppressive drugs

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18
Q

Cerebral Palsy definition and cause

A

chronic static impairment of muscle tone, strength, coordination and movement
caused by cerebral insult at birth

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19
Q

Tourette’s syndrome onset and resolution

A

mean onset age 5

Resolves by adulthood usually

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20
Q

tourettes symptoms and sleep

A

DO NOT disappear with sleep,

awake Pt may be able to suppress or camouflage tics

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21
Q

necessary length of vocal or motor tics for tourettes diagnosis

A

1 year

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22
Q

tourettes treatment

A

usually no treatment - CBT is best
neuroleptics - suppress tics
alpha adrenergic agonists - clonidine, guanfacine
DNU - ADHD drugs with Tourette’s - BBW!!

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23
Q

MS definition

A

destruction of myelin sheaths

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24
Q

MS symptoms (12)

A 
fatigue, 
depression,
 memory changes,
 pain,
 spasticity,
 vertigo, 
tremor,
 double vision or vision loss,
 weakness, 
dizziness, 
numbness,
ataxia
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25
MS diagnostic feature
Must have at least 2 episodes of symptoms that result from involvement of different areas of the CNS
26
MS treatment
interferon Beta 1- suppresses immune system Glatiramer acetate - more SE, Mitoxantrone - Cardio toxic Steroids - for acute attacks
27
Guillain barre cause
caused by infection or inocculation
28
Meningitis causes
usually bacterial | or viral
29
Meningitis cardinal symptoms (4) | Bonus (5)
``` HA, Fever, neck stiffness, altered mental status Bonus (N/V, Photophobia, focal neuro deficit, seizures, rash [non-blanching]) ```
30
Bacteria of meningitis
Strep Pneumo (kids and adults) H. flu (adults) N. Meningitidis (kids)
31
Aseptic meningitis - different from Bacterial
Spring and fall onset Caregivers - fecal-oral benign course resolves on own
32
Meningitis Diagnosis
Lumbar puncture (may need head CT first)
33
Meningitis -req. Head CT criteria
``` altered Mental status, seizure w/in 1 week of presentation, Known CNS lesion or disease, focal neuro finding papilledema >60 immunocompromised ```
34
Bacterial meningitis tx
Antibiotics AND STEROIDS - if LP is delayed for any reason, Abx first then delay (sterilization may occur within 2-4 hours so get LP ASAP) antivirals if any suspicion, If elevated ICP - mannitol, neuro consult
35
LP with 100-5000 WBC, Decreased glucose and elevated protein
Bacterial meningitis
36
LP with 10-500 WBC, normal glucose and elevated protein
Viral meningitis
37
LP with 0-500 WBC, Decreased or normal glucose and elevated protein
Fungal meningitis
38
Encephalitis symptoms
fever, HA, altered mental status, may be accompanied by seizures or Focal neuro deficit (May have meningitis too - meningoencephalitis)
39
Encephalitis - West nile treatment
supportive
40
Encephalitis - paraneoplastic & auto immune - treatment
IV IG IV Steroids resect tumor if applicable
41
Encephalitis risk factors
children or elderly Immunocompromised, Summer/ early fall
42
General encephalitis treatment
Acyclovir IV | If seizures - Benzos and Anticonvusants
43
Intracranial epidural abscess - treatment
craniotomy | Vanco +3rd or 4th cephalosporin
44
Spinal Epidural abscess
early decompression/ debridement, Antibiotics - Vanco +3rd or 4th cephalosporin 4-6 weeks
45
Parkinsonism definition
bradykinesia, with rigidity and tremor
46
Parkinson's disease symptoms
Bradykinesia, One of: resting tremors, muscular rigidity, postural instability dysautonomia causing supine HTN with orthostatic hypotension, dementia, voice and speech disorders, depression, psychosis
47
Parkinson's treatment
Levodopa, w/ dopa decarboxylase inhibitor
48
Drugs that induce parkinsonism
Bilateral symptoms Haloperidol, | thioridazine, periphenazine, anti-emetic
49
Huntington's disease - cause
genetic disorder
50
Huntington's symptoms
incoordination, abnormal movement and intellectual decline, chorea- brisk rhythmic movement, gait disturbances, dysarthria and dysphagia, Depression, OCD
51
Essential tremor - age of onset
45
52
Essential tremor - diagnosis
tremor with fine motor in hands and forearms, head tremor with no signs of dystonia, absence of other etiologic factors (should be bilateral, duration>1 year, affects daily living, family hx, better with ETOH)
53
Essential tremor treatment
propranolol, or primidone,
54
Tourette's diagnostic features
2+ motor symptoms, | 1+ vocal tics
55
Concussion Risk factors
``` Dehydration Fatigue Malnutrition Illness Illicit drug use ```
56
Frontal Concussion signs
irritability | tearfulness
57
Parietal Concussion signs
headache | nausea
58
Occipital Concussion signs
dizziness, disequilibrium, visual symptoms
59
Top of head impact Concussion signs
LOC
60
High risk concussions (3)
Double hit, Rotational force | second hit - after previous concussion
61
Concussion Diagnosis
new neuro symptoms post injury = Diagnostic | May take min to hours to develop
62
Concussion Physical signs (9)
LOC, Headache, N/V, Balance issues, incoordination, dizziness, visual changes, numbness, neck pain
63
Concussion cognitive signs (6)
confusion, amnesia, disorientation, blank stare, difficulty concentrating, slurred/slow speech,
64
Concussion emotional signs (4)
irritability, sadness, emotional labiality, nervousness
65
Concussion sleep signs (3)
drowsiness, oversleeping insomnia
66
Concussion require ED eval (6)
``` prolonged LOC C-spine injury concern high impact skull fracture concern seizure post trauma deterioration of condition ```
67
ED concussion Eval
neuro exam q 30 minutes Hx observe for 4 hours Manage symptoms
68
Concussion indications for CT
LOC Abnormal Neuro findings Deterioration
69
Concussion treatment
Responsible adult observation 6-8 hours post injury Brain rest 24-48 hours Physical rest until symptom free NSAIDS and Acetaminphen (NO cognition altering meds - opioids, muscle relaxants, Benzos, ETOH)
70
Concussion return to school notify
teachers, counselor, nurse, athletic trainer, coach
71
Return to play post concussion
Successful return to full school day symptom free off meds normal neuro exam Back to base line balance and cognitive performance
72
Chronic traumatic encephalopathy - cause and diagnosis
Tau proteins due to repeated Concussions | Post mortem diagnosis
73
Epidural hematoma description
arterial bleed, pocket of blood, often with skull fracture Pt usually lucid --> rapid deterioration, severe HA, Vomiting, Seizure
74
Subdural hematoma description
Venous bleed Crescent moon shape following skull curvature, no skull fracture LOC or coma in acute onset Chronic - HA, Dizziness, cognitive impairment, seizures
75
Subdural hematoma timeline Acute, Subacute, Chronic
Acute 1-2 days post trauma Subacute 3-14 days post trauma Chronic >15 days post trauma
76
Acute subdural hematoma (symptomatic) treatment
Neurologic emergency | surgical decompression - craniotomy
77
Epidural Hematoma treatment
Neurologic emergency, | surgical decompression - craniotomy
78
Epilepsy definition
>2 unprovoked seizures
79
Simple partial seizures - signs and symptoms
preserved consciousness, seconds to minutes in duration | May be motor, sensory, autonomic,
80
Simple partial seizures - treatment
Anti-epileptic drugs if recurrent | Surgery if medically refractory
81
Complex partial seizure - sign and symptoms
impaired consciousness 60-90 seconds w/o recollection of seizure Behavioral arrest followed by staring, automatism, and post ictal confusion
82
Types of generalized seizure (6)
``` Absence - staring Myoclonic - rapid jerks atonic - flaccid tonic - 10-20 second rigid extended extremities Clonic - 1-2 min tremors Tonic-clonic ```
83
Absence seizures tx
ethosuximide
84
Generalized seizures (not absence) tx (4)
valproic acid, Lamotrignine, topiramate, levetiracetam
85
tonic - clonic additional tx (3)
zonisamide, phenytoin, carbamazepine
86
Tonic - clonic post ictal phase
amnesia, variable consciousness, stuporous then gradually awakens to confusion/agitation/combative
87
Causes of seizures
Primary | Secondary - drugs, infections, metabolic, structural
88
Seizures and ETOH withdrawal
If any concern for ETOH withdrawal - ADMIT PT - will get much worse over next 10 days if untreated
89
Status Epilepticus
Seizure > 5-10 minutes | 2 seizures without lucid interval
90
Acute seizure management -> status epilepticus
Airway protection, Benzos, Induce coma
91
Stroke in Pregnancy (2)
Urgent Head CT for CVA, and | think Eclampsia
92
Criteria for febrile seizure
Duration <15 minutes Fever >100.4 Age 6 months - 5 years no more than 1 seizure in 24 hours
93
PNES or Pseudo seizure
Psych diagnosis conversion disorder EEG video monitoring for definitive diagnosis
94
Anti epileptic tx
Treat after 2nd seizure or if significant need avoid driving for 6 months if 2nd seizure meds for 1 year
95
Anti epileptic drugs (9)
``` valproic acid Phenytoin carbamazepine levetiracetam topiramate lamotrigine zonisamide ethosuximide phenobarb ```

My Clin Med 4 (4 decks)

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