Neuro Cases Flashcards
headache qs
acute vs chronic, location / lateralization, duration, timing, photophobia/auras, neck stiffness, n&v, jaw claudication, trauma / Sx, sinusitis, exacerbating/ alleviating facctors
workup headache
cbc, ct, mri, lp, crp / dopper us/biopsy for temporal arteritis
sudden, severe headache
subarachnoid hem, use NCC to image, pt/ptt/inr
sinusitis imaging
xr sinus, ct, lp (csf anaysis)
pseudotumor cerebri
urine hCG, cbc, head ct, opening pressure
trigeminal neuralgia
cbc, esr, mri brain
memory loss qs
course of deficits, collateral info (from family etc), delirium screen (waxing/waning?), falls, med changes/polypharmacy, associated Sx (incontinence, fevers, chills, weight loss, ataxia, hypothyroid, depression), Hx stroke or vascular dz, etoH, b12 deficiency, FHx of Alzheimer’s etc
memory loss workup
cbc, b12, tsh, MRI/ct, vdrl/rpr, LP
alz dz imaging
MRI preferred
cjd workup (myoclonus, ataxia, startle)
elecrolytes/ Ca, EEG, LP, brain Bx
hypoglycemia w/u
glucose, cbc, electrolytes, cpk-mb, troponin, echo, ecg, mri brain, doppler u/s carotid
vision loss qs
acute vs chronic, time course, pain, discharge, itching tearingn, redness, photophobia, weakness/uimbness. Hx cardiac, rheum, thrombotic, autoimmune, neuro. jaw claudication, meds, trauma
retinal artery occlusion (a fib, vision loss in one eye) wu
fluorescein angio, echo, dopper carotids, intraocular tonometry, esr, temporal artery bx, cbc
retinal artery occlusion differential
vein occlusion, acute angle closure, retinal detachment, temporal arteritis
depression qs
sig e caps (sleep, interest/anhedonia, guilt, concentration, psychomotor agitation/retardation…), previous episodes, drugs/etoh/meds, social
depression exam and wu
MSE, appearance, behavior, speech, mood, affect, thoughts. tsh, cbc, u tox, Beck depression inventory
psychosis qs
+ (hallucinations, delusions, thought disorganization), - (blunted affect, social withdrawl, decreased motivation/speech/thought)
substance induced psychosis
u tox, tsh, cbc, MSE, electrolytes, bun/cr, ast/alt
dizziness qs
vertigo vs lightheaded (is the room spinning or? ), duration, positioing or post head trauma, visual disturbance, URI, nausea, neck pain, meds, atherosclerotic vascular dz
dizziness ex
vitals, neuro ex (+romberg, nystagmus, dix halpike, weber/rinne), ent, cardio.
diziness wu
/cbc, electrolytes, mri brain. vdrl / rpr (for Meniere’s dz), orthostatic bp change/flurosemide or hydrochlorothiazide etc use/ stool or diarrhea hx for dehydration, dix/mri brain/audiogram from bph. mri/mra for labryinth and vestibular neuronitis
dizziness ddx
Meniere’s, vestibular neuronitis, labryinthitis, bpv, acoustic neuroma if sensorineural, vertebrobasilar insufficiency, brainstem or cerebellar tumor, cervical spine dz/injury vertigo
vestibular neuronitis vs labryinthtis
both morning, n& v, URI a few days ago, but vestibular has no hearing loss while labryinth does
LOC hx
nausea, diaphoresis, palpitations, pallor, lightheaded, exertional/postural/calustrophobic/dehydration/trauma/stress. tongue biting, incontinence, tonic cllonic, prolonged confusion, dypsnea or PE risk, arrythmia, htn, diabetes, etoh and alcohol use.
LOC ex
vitals (bp standing vs sitting), neuro, carotid and cardiac, lung, lower limbs
LOC w/u
cbc, electrolytes, glu, u tox. eeg, mri/ct (seizures). echo, ecg, holter (syncome via orthostatic hypotension or arrythmia). v/q, cta, d-dimers for PE
numbness/weakness Hx, ex
distribution (prox, distal…unilateral or not), progression, pain, diabetes, athero, etoh. ex neuro, msk, vitals, vascular
numbness w/u
ct head/mri, cpc, electolytes, glu, lipid panel, ecg, echo, dopper u/s. nerve conduction/ edrophonium for myastheia ruleout for gbs, retinal evoked potentials for MS
fatigue hx, ex
sleep hygeine, stress etc, thyroid, anemia, meds/etoh/caffeine/drugs. vitals, ent (conjnctival pallor, tonsils, lymph nodes, thyroid), heart, lung, abdo quickly. pallor, coolness at distal extremeties
fatigue wu
cbc, tsh, u tox, electrolytes, bun/cr, Ca, fasting glucose, hba1c, UA, std tests. polysomnography and noctural pulse ox for sleep apnea (evaluate if cpap useful),
glove and stocking numbness and tingling
diabetic or alcoholic peripheral neuropathy, hypocalcemia, hyperproteinemia/myeloma, hyperventilation(?)
tingling/numb median nerve distrib, progressive, fatigue, weight gain
carpal tunnel 2ndary to hypothyroidism. overuse injury median nerve, medial epicondylitis
fatigue, weight loss, constipation. FHx of this dz
colon ca. hypothyroidism, renal failure (hypercalcemia-constipation, stones, abdo moans, psych groans), depression.
fatigue, thirst, polyuria, increased appetite
DM (type 1), primary polydipsia, DI, atypial depression
insomnia Hx, Ex
duration, earning morn vs multiple awakenings vs trouble sleeping, daytime sleepiness. arthritis, diabetes. snoring, nightmares, depression. substances (caffeine, etoh, meds, illegal), shift work, jet lag, sleep hygiene, stress, psychiatric
ex: vitals, mse, thyroid
insomnia wu
cpc, tsh, mse, polysomnography, ecg
insomnia ddx
circadian rhythm sleep disorder, depression, primary hypersomnia, osa, caffeine or stress induced
neck mass hx
socrates, mobility, mvmt with swallowing (thyroglossal duct cyst or not), obstructive(sob, dysphagia), associated sx (heme, constitutional-likelier ca, GI, endo, pulm), sick contacts, other masses like lymph nodes
neck mass ex
heent, lymph nodes, spleen, tonsils. heart, lung, abdo
neck mass wu
cbc (& differential ie wbc), euc, esr/crp, lymph node bx, ppd, cxr, tsh, thyroid us, upper endoscopy
neck mass ddx
hodgkin’s/nhl, tb, thyroid nodule
