Neuro CIS Case 2

Question 1

etiology for weakness/fatigue/tremor and falls

Answer 1

neurologic
cardiac
metabolic
MSK

Question 2

neurologic etiology

Answer 2

parkinsons, AZD, lewy body dementia, benign familial tremor

Question 3

cardiac etiology

Answer 3

arrhythmia, valvular

Question 4

metabolic etiology

Answer 4

anemia, electrolyte disturbance, thyroid,EtOH use

Question 5

MSK etiology

Answer 5

DJD, OA, joint laxity

Question 6

tremor that goes away with voluntary muscle contraction

Answer 6

resting tremor

Question 7

tremor that occurs when extending upper limbs horizontal, pointing at objects, sitting erect without support for the upper body

Answer 7

postural tremor

Question 8

tremor that occurs during any voluntary contraction of skeletal muscle
finger to nose test, heel to shin test, reaching, writing, drawing, pouring a glass, eating etc

Answer 8

action tremor including kinetic and isometric tremor

Question 9

PD tremor

age of onset
gender
fam history
asymmetry
freq
character
distribution
assocaited features

Answer 9

AOS: 50
males
25% family history
assymetry
4-6 hz
at rest, supination and pronation
hands, legs, chin, tongue
bradykinesia, rigidity, gait difficulty, postural instability, micrographia

Question 10

Essential tremor (differentiation from PD tremor)

age of onset
gender
fam history
asymmetry
freq
character
distribution
assocaited features

Answer 10

20s and 60s
M=F
>50% family history
little asymmetry
4-10 hz
postural, kinetic
hands, head, voice
deafness, dystonia, parkinsonism

Question 11

is parkinsons disease progressive

Answer 11

yes

Question 12

3 main features of parkinsons (triad)

Answer 12

tremor (pill rolling)
bradykinesia
rigidity

Question 13

non motor symptoms with parkinosns

Answer 13

depression, anxiety, psychosis

Question 14

clinical diagnosis of parkinsons

Answer 14

triad plus response to L-Dopa (only way to really confirm would be at autopsy)

Question 15

masked facies and micrographia associated with what and explain what each is

Answer 15

associated with PD

masket facies = flat facial expression
micrographia = tiny handwriting

Question 16

treament for PD

Answer 16

levodopa

dopamine agonist: bromocriptine, and pramipexole

Question 17

warfarin indicatred use and INR target

Answer 17

A fib- 2-3
VT/PE 2-3
bioprostehtic valve 2-3
mechanical valve 2.5-3.5

Question 18

most common cause of supratherapeutic INR

Answer 18

interaction with warfarin and its metabolism

Question 19

if INR is above 5 then what to do

Answer 19

lower warfarin dose or omit dose until range goes back to normal

-no reduction needed if INR only minimally prolonged

Question 20

if INR is 5-9 then what

Answer 20

omit next 1-2 doses, monitor and resume at lower dose when INR in therpeutic range

-or omit dose and administer 1-2.5 mg oral vitamin K1

Question 21

INR over 9 then what

Answer 21

hold warfarin
administer 2.5-5 mg oral vitamin K (administer more prn)
resume warfarin at lower dose

Question 22

when INR is life threatening what to do

Answer 22

hold warfarin and administer 10 mg of vitamin K by slow IV infusion

supplement with 4-factor PCC or FFP

Question 23

why non-contrasted CT head

Answer 23

contrast will obscure blood

Question 24

mini mental exam questions category

Answer 24

orientation

registration

attention and calculation

recall

language

(go over handout)