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Clin Med 2 > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

Headaches Broad Overview

Tension HA

A
  • neck/muscle tension
  • MC type of HA
  • TX via OTC NSAIDS and PT
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2
Q

Headaches Broad Overview

Migraines

A
  • chronic and episodic
  • +/- aura’s
  • high morbidity
  • Tx goals aimed at acute resolution (sumatriptan) vs PPx meds (propranolol)
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2
Q

Headaches Broad Overview

Cluster HA

A
  • intermittent cluster’s
  • typically unilateral (around eyes/temple)
  • autonomic sx involvement
  • Tx 1st line via 100% O2
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3
Q

Headaches Broad Overview

Intracranial HTN HA

A
  • papilledema on exam
  • Neuro sx’s
  • TX via Therapeutic LP (lower ICP) and Acetazolamide
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4
Q

Headaches Broad Overview

Trigeminal Neuralgia HA

A
  • super painful sensation on face worsened with touch
  • missed diagnosis!!
  • SEVERE shooting pain on face
  • TX via anti-epileptics (carbamazepine)
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5
Q

Headaches Broad Overview

TMJ HA

A
  • HA caused by TMJ
  • avoid chewing gum/clenching teeth
  • TX via addressing cause (mouth guard? botox?)
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6
Q

Headaches Broad Overview

Meningitis HA (bacterial)

A
  • triad: headache, fever, nuchal rigidity
  • PE signs -> Nuchal, Brudzinski, Kernig
  • Tx via IV abx and steroids
  • LP CONFIRMATORY (elevated ICP, elevated protein, low glucose)

Abx = IV Cefotaxime or Ceftriaxone

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7
Q

Headaches Broad Overview

Brain Tumor HA

A
  • HA qAM and N/V
  • glioblastoma = BAD (high mortality w/i a few years)
  • meningioma = benign
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8
Q

Headaches Broad Overview

Subarachnoid Hemorrhage HA

A
  • ACUTE onset SUDDEN severe HA
  • “worse HA of life”
  • EMERGENCY
  • Diagnostics via CT then LP (blood in LP)
  • TX vis NSG
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9
Q

Migraine’s

Pathophysiology?

A

trigeminal dysfunction -> CGRP and neuropeptide release -> inflammation and HA -> further mediator release -> further dilation/pain

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10
Q

Migraine’s

Pathophysiology of Migraine aura?

A

cortical spreading depression -> wave of depolarization corresponding to clinical sx’s (occipital cortex and visual aura)

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11
Q

Migraine’s

Typical migraine presentation?

A
  • lateralized throbbing “pulsatile” HA
  • mod-severe and worse w/ activity
  • Assoc. sx’s = N/V, photophobia, phonophobia
  • last 4-72 hrs
  • +/- preceding aura (scintillating scotomas)

scintillating scotomas = twinkly lights and blurry

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12
Q

Migraine’s

Familial Hemiplegic Migraine presentation?

A

attacks of lateralized weakness represent the “aura”

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13
Q

Migraine’s

Migraine with brainstem aura presentation?

atypical migraine

A

blindness or visual disturbance throughout BOTH visual fields -> dysarthria & dysequilibrium -> transient LOC

think brainstem involvement involved with coordination

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14
Q

Migraine’s

Recurrent Painful Opthalmoplegic Neuropathy presentation?

atypical migraine

A

eye pain with N/V and diplopia (d/t CN3 palsy)

diplopia = double vision

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15
Q

Migraine’s

Work-Up?

what testing, when

A
  • labs/imaging only done to r/o other disorders
  • WORK-UP FOR SURE in secondary HA’s!

secondary HA criteria = onset > 50y/o, focal deficit, refractory HA, thunderclap HA, new HA w/ h/o CA or HIV

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16
Q

Migraine’s

Non-pharm management?

A

rest, quiet dark room

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17
Q

Migraine’s

Symptomatic Pharm Tx (home)

A

1st line = Sumatriptan (abortive mgmt)
+/- antiemetics (Metoclopramide)
Mild/Moderate = Tylenol or Motrin

last option = ergotamines (DHE, cafergot)

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18
Q

Migraine’s

ER Managment of Migraine?

A

Pain med (toradol) + anti-emetic (metoclopramide) + benadryl

IV 15-30mg Toradol + IV 10mg Metoclopramide + IV 25mg Benadryl + 1L NaCl

avoid opioids -> rebound HA and use Dexamethasone in resistant cases

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19
Q

Migraine’s

When is pharm ppx tx indicated?

ppx = prophylatic

A
  • > 2-3 attacks/month
  • significant disability with HA
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20
Q

Migraine’s

What pharm options are used for ppx tx?

A

**1st line = Propranolol **
also consider TCA’s (Ami/Nortriptyline)

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21
Q

Migraine’s

What other tx options are there for migraine’s outside of pharm options?

A
  • avoid triggers (caffeine, sleep hygiene, hydration)
  • monoclonal ab tx (refratory cases) -umabs
  • Acupuncture
  • Botox
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22
Q

Tension Headaches

Etiology/Pathophysiology?

A
  • MC type of HA
  • can last anywhere from < 1day/month (infrequent) to 1-14days/month (frequent) or >15days/month (chronic)
  • likely d/t increased neuronal sensitivity (w/ increased muscle tenderness)
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23
Q

Tension Headaches

Clinical presentation?

A
  • “band-like” mild to mod pain around head “pressure, tight, achy”
  • non-pulsatsing typically
  • NO FOCAL DEFICITS
  • less likely photo/phonophobia
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24
Q

Tension Headaches

Potential PE findings?

A

possible muscular tenderness (pericranial) w/ otherwise nml exam

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25
Q

Tension Headaches

Tx options?

A

**1st line -> OTC analgesics **(tylenol, motrin, ASA) for acute pain
PPx tx -> TCA’s (triptylines)

NO triptans or ergotamines!!!

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26
Q

Cluster Headache

Etiology/Pathophysiology?

A

activation of hypothalamic system triggering trigeminal autonomic vascular system
- MC in middle aged men

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27
Q

Cluster Headache

Features?

A
  • last 15 min to 3 hours
  • worse at night
  • triggers = EtOH, Nitro (NTG), histamine
  • cluster of HA’s over weeks to months
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28
Q

Cluster Headache

Presentation?

A

severe unilateral pain PLUS autonomic sx’s on IPSI-lateral side
- nasal congestion, rhinorrhea, conjunctival irritation, horner syndrome

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29
Q

Cluster Headache

What is Horner syndrome?

A

ptosis, pupillary miosis (constriction), and facial anihidrosis in the setting of a cluster HA

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30
Q

Cluster Headache

Abortive tx?

A

100% O2 at 12-15L/min for 15 min
2nd line = Sumatriptan

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31
Q

Cluster Headache

Ppx tx?

A

Calcium-channel blocker (Verapamil) (last line, lithium)

can consider suboccipital corticosteroid injection at greater occipital n. AND/OR short course of prednisone taper

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32
Q

Medication Overuse Headaches

Features?

A
  • chronic daily HA’s
  • HA’s tend to be resistant to any tx (>3 months)
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33
Q

Medication Overuse Headaches

What common meds can result in medication overuse HA’s?

>10 days and >15days

A
  • > 10 days/month = ergotamines, triptans, meds w/ butalbutal, opioids
  • > 15 days/month = acetaminophen, acetylsalicyclic acid (ASA), NSAIDS
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34
Q

Medication Overuse Headaches

Tx options?

A

**initiation of migraine preventive therapy
**- ppx propranolol
- sleep hygiene
- avoid triggers

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35
Q

Secondary Headaches

Describe trigeminal neuralgia?

A
  • recurrent brief episodes of unilateral electric shock-lick pains
  • abrupt in onset and termination
  • distributed through one+ divisions of CNV
  • +/- triggered by innocuous stimuli
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36
Q

Secondary Headaches

Describe TMJ dysfunction?

A
  • acute or chronic pain
  • pain and clicking of TMJ joint
  • HA and earache common
  • avoid chewing gum
  • wear mouth guard
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37
Q

Secondary Headaches

Vascular causes of secondary HA?

A
  • subarachnoid hemorrhage (thunderclap)
  • intracranial aneurysm
  • arteriovenous malformation
  • thrombosis
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38
Q

Secondary Headaches

What are some other causes of secondary HA’s?

not trigem neuralgia, TMJ, or vascular causes

A
  • infectious (abscess, encephalitis, meningitis)
  • brain tumor
  • mass
  • lesion
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39
Q

Trigeminal Neuralgia

Etiology/Features

“Tic douloureux”

A

partial demyelination of trigemninal nerve or impingement on nerve by anomalous artery or vein
- triggered by eating, talking, washing face
- women > men

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40
Q

Trigeminal Neuralgia

Presentation?

A
  • severe episodic episodes of facial pain
  • pain triggered by touch, movement, drafts, and eating
  • may have remissions for several months
  • can progress and become more frequent/dull ache may persist
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41
Q

Trigeminal Neuralgia

Evaluation?

A
  • usually clinical BUT consider MS if < 40 y/o
  • MRI to r/o secondary causes
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42
Q

Trigeminal Neuralgia

Med mgmt?

A

1st line = Carbamazepine (or oxcarbazepine)
- +/- NSAIDS or opioids
- surgery (microvascular decompression) if MED RX FAILS

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43
Q

Post-Herpetic Neuralgia

Overview? Mgmt?

A

the pain pt’s have AFTER shingles
- antivirals when given w/i 72hr of rash onst REDUCE incidence
- Med Mgmt = TCA’s, gabapentin, botox

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44
Q

TMJ Syndrome

Overview? Etiology?

A

MCC of facial pain!
- etiology = stress, bruxism, faulty dentures, hypermobility syndrome
- females > males

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45
Q

TMJ Syndrome

Exam findings?

A
  • pain worse w/ jaw movement
  • clicking of jaw
  • restricted ROM
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46
Q

TMJ Syndrome

Tx options?

A

Treat underlying cause!
- NSAIDS, dental referral, OMF’s

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47
Q

Subarachnoid Hemorrhage

etiology?

A

bleed from ruptured aneurysm (arterial sacular berry aneurysm)
- high mortality rate!!!

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48
Q

Subarachnoid Hemorrhage

Risk Factors?

A
  • female
  • older age
  • smoking
  • HTN
  • family hx
  • etoh use
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49
Q

Subarachnoid Hemorrhage

Presentation?

A

“thunderclap” headache/“wost headache” of my life
- N/V
- LOC
- neuro deficits

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50
Q

Subarachnoid Hemorrhage

PE findings?

A
  • nuchal rigidity
  • confused
  • irritable
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51
Q

Subarachnoid Hemorrhage

Diagnostics?

A
  • imaging = CT-head noncontrast (if negative move to LP)
  • LP = Xanthochroma
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52
Q

Subarachnoid Hemorrhage

Management?

A

BP Control and vasospasm of cerebrum control + Neurosurgery consult + CTA to eval for additional aneurysms
- target BP < 140 (avoid HOTN)

IV Nicardipine (or labetalol) + Neuro consult (coil embolization/clipping/micro-excision of AVM) +** CTA** + 2 week hospitalization

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53
Q

Subarachnoid Hemorrhage

Potential Complications?

A
  • vasospasms (2-12 s/p bleed) = tx w/ Nimodipine
  • Hydrocephalus (may require shunting)
  • Cerebral salt washing (hyponatremia)
  • Hypopituitarism (late complication)
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54
Q

Subarachnoid Hemorrhage

What grading scale is used to evaluate prognosis?

A

Hunt Hess
- 1 = mild HA, nml mentation, no neuro deficits, minimal nuchal rigidity
- 2 = severe HA, nml mentation, +/- CN deficit
- 3 = somnolent, confused, +/- CN deficit or motor deficit
- 4 = stupor, mod-severe, +/- posturing
- 5 = coma, flaccid

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55
Q

Intracranial Aneurysms

Etiology?

A
  • MC in anterior portion of COW (circle of willis)
  • usually asymptomatic
  • 4% of population
56
Q

Intracranial Aneurysms

Tx options?

A

Treatment Goal = prevent hemorrhage via surgical or endovascular

57
Q

AV Malformations

Etiology? Features?

A
  • most life in region of MCA and range in size
  • up to 70% bleed at some point (MC < 40 y/o)
  • high rate of re-bleed and 10% assoc. aneurysm
58
Q

AV Malformations

Presentation?

A
  • hemorrhage
  • recurrent seizures (frontal or parietal AVM)
  • Focal deficits
  • obstructive hydrocephalus (brainstem/cerebellar)
59
Q

AV Malformations

Tx options?

A

Surgical = excision
embolization
anti-seizure meds

60
Q

Intracranial Venous Thrombosis

Etiology? Overview?

Cerebral Venous Sinus Thrombosis

A

MC associated with post-partum pregnancy
- HA, seizures, drowsy, confusion, increased ICP, focal neuro deficits

61
Q

Intracranial Venous Thrombosis

Diagnostics?

A

MR venography definitive

62
Q

Intracranial Venous Thrombosis

Mgmt options?

A
  • consult neuro
  • anticoagulation (heparin)
  • +/- antiseizure meds and reduced ICP prn
63
Q

Brain Abscess

Types of spread?

A
  • Direct spread = mastoiditis, sinusitis, dental infection
  • Hematogenous spread (typically multiple) = PNA, endocarditis, pyelonephritis
64
Q

Brain Abscess

What diagnostic procedure do you avoid?

A

LP! risk of herniation d/t space-occupying lesion increasing ICP

65
Q

Brain Abscess

Presentation?

A
  • HA
  • fever
  • altered LOC
  • hemiparesis (other focal deficits)
  • N/V
  • seizure
66
Q

Brain Abscess

Mgmt options?

A
  • imaging CT or MRI (do not LP)
  • Tx via antibiotics (abscess usually polymicrobial) = coverage for S. aureus, gram neg, strep, and mouth anaerobes
67
Q

Brain Tumors/Lesions/Mass

Primary?

A

meningioma’s, glioma’s, pituitary adenomas

68
Q

Brain Tumors/Lesions/Mass

Metastatic?

A

MC from carcinoma of the lung (also breast, kidney, melanoma, and GI tract)

69
Q

Brain Tumors/Lesions/Mass

Imaging of choice?

A

MRI!

70
Q

Brain Tumors/Lesions/Mass

Presentation?

A
  • HA
  • seizures
  • focal neuro deficits (weakness, paralysis, sensory deficits, CN palsies)
  • visual changes
  • ataxia
  • AMS (intellectual decline and perosnality changes)
71
Q

Brain Tumors/Lesions/Mass

Key feature of headaches with brain tumors?

A

progressively worsening over days to weeks AND often worse in the AM w/ vomiting

72
Q

Astrocytoma

Overview? Etiology? Grades?

A

arise from astrocytes (type of glial cell)
- MCC site = cerebral hemispheres
- Worst grade = glioblastoma multiforme
- less bad is astrocytoma (but typically progresses to glioblastoma)

73
Q

Astrocytoma

How does it appear on imaging?

A
74
Q

Astrocytoma

Glioblastoma multiforme on imaging?

A
75
Q

Astrocytoma

Managment options?

A

1st = surgery to remove/decrease bulk (risk of neuro injury)
after surgery -> radiation (targets microscopic dz via “gamma knife”)
+/- chemo in adjunct w/ surgery and radiation

76
Q

Meningioma

Overview?

A

arise from meninges (commonly on surface of brain)
- usually benign = grow slow, 2% malignant, 5 year survival good

77
Q

Meningioma

Management?

A
  • Obvs if small/asx and regular f/u imaging
  • Surgical best results if superficial/easily accesible
  • Radiation if surgical resection incomplete (good for recurrence)
  • Chemo usually not effective
78
Q

Cerebral Metastasis?

MC source of cerebral metastasis?

and work-up

A

lung
- systemic work-up for primary source (CT c/a/p)

79
Q

Cerebral Metastasis

Management?

A
  • mainly palliative
  • whole brain radiation therapy (mainstay tx option); s/e include HA, nausea, cerebral edema
80
Q

Primary and Metastatic Spinal Tumors

overview? dx? tx?

A
  • leads to spinal cord dysfunction d/t compression, ischemic, or invasive infiltration
    -** insidious onset**
  • bowel/bladder dysfunction
  • DX via MRI w/ contrast (or CT myelography)
  • TX via decompression and surgical excision if possible
81
Q

Idiopathic Intracranial HTN

Overview? Features? Causes?

A

headache worse with straining
- causes = chronic pulm disease, SLE, uremia, tetracycline, OCP’s, overweight women 20-44

82
Q

Idiopathic Intracranial HTN

Exam findings?

A

Papilledema and Abducens palsy

83
Q

Idiopathic Intracranial HTN

Signs/Sx’s

A
  • HA
  • Diplopia
  • Papilledema
  • tinnitus
84
Q

Idiopathic Intracranial HTN

Diagnostics?

A

**Confirmatory = LP **
- labs help exclude other causes
- CT or MRI can show small/nml ventricles

85
Q

Idiopathic Intracranial HTN

Treatment?

A

1st line = Acetazolamide (reduces formation of CSF)
- therapeutic LP
- Tx underlying cause
- untreated -> secondary optic atrophy and permanent vision loss

86
Q

SPECT scan

A

evals blood flow to “map” for epilepsy surgery

87
Q

PNS Disorders

Anterior Horn Cell Disorders?

A
  • ALS
  • Spinal Muscular Atrophy (genetic)
  • Poliomyelitis (acquired)
88
Q

PNS Disorders

Peripheral Nerve Disorders?

A

Guillain-barre syndrome

89
Q

PNS Disorders

Neuromuscular junction disorders?

A

myasthenia gravis

90
Q

PNS Disorders

muscle disorders?

A

duchenne and becker

91
Q

Essential Tremor overview

A
  • familial tremor
  • typically > 60
  • progressive sx’s
    -** POSTURAL tremor of HANDS **(not at rest)
  • 4 criteria = tremor of UE, absence of other neuro sx’s, 3+ years
  • Tx = EtOH improves sx’s, Propranolol

  • r/o albuterol, caffeine, cocaine, nicotine, and thyroid issues
92
Q

Parkinson Disease

Essentials?

A
  • Progressive neurodegenerative disease w/ motor and mental changes
  • onset 45-65 y/o
  • RF = age, familial hx, prior head trauma
  • dopamine and Ach imbalance in niagrostriatal pathway

too little dopamine and too much AcH

93
Q

Parkinson Disease

Symptoms?

A

-** pill rolling tremor AT REST** (tremors worsen with stress)
- bradykinesia
- shuffling gait
- masked like facial expression
- +/- affective d/o, fatigue, or sleep d/o
- Myerson sign (repetitive tapping over bridge of nose sustained blink)
- cogwheel/lead pipe rigidity

94
Q

Parkinson Disease

Tx Mgmt?

A

goal of tx is directed at imbalance of dopamine and AcH
1st line = Amantadine (mild sx’s)
Mod-severe = Levodopa-carbidopa (doesn’t stop progression)
- Selective MAO-I (inhibit dopamine breakdown)
- COMT (sustain plasma dopamine stimulation)
- Anticholinergic meds (benztropine) = alleviate EPS sx’s

use dopamine agonist (pramipexole) in conjunction w/ levo to reduce dyskinesia’s

95
Q

Parkinson Disease

Non-pharm mgmt?

A

PT and Deep brain stimulation (can benefit motor sx’s)

96
Q

Huntington Disease

Essentials?

A
  • familial and autosomal dominant
  • unstable gene -> atrophy of caudate nucleus and putamen
  • 30-50 y/o onset and fatal w/i 15-20 yrs
97
Q

Huntington Disease

Signs/Sx’s?

A
  • abml movements/intellectual changes -> chorea + dementia
98
Q

Huntington Disease

Confirmatory diagnostics?

A

Genetic testing!!!

99
Q

Huntington Disease

Mgmt?

A
  • no cure or halt in progression…
  • sx tx (PT/OT/palliative care)
  • Tetrabenazine (treat dyskinesia)
  • Offer offspring genetic testing!!!
100
Q

Restless Leg Syndrome

Essentials?

A

d/t primary (idiopathic) or secondary to PD, pregnancy, IDA, or peripheral neuropathy
- hereditary component in 1/2 pts
- sleep movement disorder

101
Q

Restless Leg Syndrome

Signs/Sx’s?

A
  • unpleasant/uncomfortable **urge to move legs **
  • worse at night
  • involuntary flexion at ankle/knee/hip
102
Q

Restless Leg Syndrome

Tx?

A
  • Iron replacement if low (TIBC, Transferrin, Ferritin)
  • Avoid caffeine/etoh
  • Chronic and Significant -> Gabapentin
103
Q

Multiple Sclerosis

Essentials?

A
  • autoimmune etiology w/ genetic susceptibility
  • onset < 55y/o with F>M
104
Q

Multiple Sclerosis

Pathophys?

A

**demyelination **w/ reactive gliosis in **white matter of brain/spinal cord/optic nerves **

105
Q

Multiple Sclerosis

Relapsing/Remitting type?

A

months/years interval before new sx’s develop or original symptoms recur then develops into -> secondary progressive type

106
Q

Multiple Sclerosis

Secondary-progressive type?

A

steady deterioration unrelated to acute relapses

107
Q

Multiple Sclerosis

Symptoms?

A
  • episodic weakness/numbness/tingling
  • unsteadiness in a limb
  • spastic paraparesis
  • optic neuritis
  • diplopia
  • sphincter disturbance
108
Q

Multiple Sclerosis

Diagnostics?

A

Imaging of choice -> MRI brain/cervical cord (r/o other neuro causes); T2 images show multiple lesions at diff. points in time
LP -> csf

109
Q

Multiple Sclerosis

Diagnostic Criteria?

A
  • 2 or more regions of white matter affected at diff times (dissemination in space & time)
  • 2+ typical attacks and objective evidence on exam
110
Q

Multiple Sclerosis

Tx/Mgmt?

A
  • goal aimed at preventing relapses
  • steroids -> quicken relapse recovery
  • severe dz -> immune-modulators
  • interferon/immune modulators reduce frequency of attacks (glatiramer)
111
Q

Amyotrophic Lateral Sclerosis

Essentials?

Lou Gehrig’s

A

relentlessly progressive neurogenerative disorder
- upper/lower motor neuron deficit in lumbs d/t degen. of ant. horn cells (spinal cord)
- cognitive decline
- several genetic loci

112
Q

Amyotrophic Lateral Sclerosis

UMN Sx’s?

A

motor movement -> spasticity
- weakness, slowness, hyperreflexia, spasticity

113
Q

Amyotrophic Lateral Sclerosis

LMN sx’s?

A

prevent excessive muscle movement -> flaccidity
- weakness, atrophy, amyotrophy, fasiculations
- incomplete eye closure, facial weakness
- progresses to diaphragmatic weakness & resp failure

114
Q

Amyotrophic Lateral Sclerosis

Bulbar Sx’s?

A

UMN of CNs
- diff chewing, swallowing, coughing, breathing, etc

115
Q

Amyotrophic Lateral Sclerosis

Diagnostics?

A
  • EMG = show acute on chronic denervation w/ reinnervation throughout multiple regions, reduced motor velocity, sensory conduction nml
  • Muscle Bx = denervation (not needed for dx)

serum CK may be elevated

116
Q

Amyotrophic Lateral Sclerosis

Tx?

A

usually fatal w/i 3-5 years from pulmonary dz
- Glutamate blocker (Riluzole) increases short-term survival
- Free-radical scavenger (Edaravone) slows dx progression
- ventilation and tracheostomy
- supportive measures, PT/OT

117
Q

Guillan-Barre

Essentials?

A
  • Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
  • can affect all myelinated nerves (motor, sensory, cranial, sympathetic)
  • Rapidly progressing demyelinating disorder of motor neurons
  • association with post-viral (campy, CMV, EBV, Flu, HSV, Covid, Zika)
118
Q

Guillain-Barre

Symptoms/Signs?

A
  • ascending symmetrical progressive proximal weakness over 1-4 weeks -> paralysis
  • legs -> face
  • reflexes reduced or absent
  • ER if tachycardia, HOTN/HTN, facial flushing, diaphoresis, sphincter control
119
Q

Guillan-Barre

Diagnostics?

A
  • CSF (>1k) elevated protein & nml cells
  • EMG -> slowing of velocities
  • MRI -> spinal root enhancement
120
Q

Guillan-Barre

Mgmt?

A
  • no tx if sx’s minimal or improving
  • admit
  • IVIG or plasmapharesis if ventilation affected OR rapidly worsening

GOOD PROGNOSIS

121
Q

Bell Palsy

Essentials?

A

facial paralysis of lower motor neuron type
- idiopathic but can be d/t HSV (or VZV)
- RF = pregnancy and DM

122
Q

Bell Palsy

Pathophy?

A

inflammation involving CNVII (facial) near stylomastoid foramen or in bony facial canal

123
Q

Bell Palsy

Signs/Symptoms?

A
  • +/- preceding ear pain -> acute onset facial paralysis and weakness
  • vesicles in ext. ear canal? HSV concern
  • otherwise nml neuro exam
124
Q

**Bell Palsy **

Tx?

A

60% of cases resolve w/o tx BUT corticosteroids increase chances of recovery and recommended in all new onset pts

125
Q

Myasthenia Gravis

Essentials?

A
  • MC in young females
  • autoimmune, thymoma (thymic tumor), small cell CA (lambert-eaton), RA
  • insidious onset
  • exacerbated concurrent infection, prior to menses, and during/after pregnancy
126
Q

Myasthenia Gravis

Pathophys?

A

T-cell mediated block of neurotransmitters by autoAb binding to AcH receptors

127
Q

Myasthenia Gravis

What drugs can exacerbate sx’s?

A

D-pencillin, aminoglycosides, BB’s, Ca-channel blockers, laxatives (Mg), gad

128
Q

Myasthenia Gravis

Signs/Sx’s?

A
  • ptosis, diplopia, difficulty chewing/swallowing, limb weakness
  • fluctuation progressive weakness of voluntary muscles
  • commonly affects EOM
  • ACTIVITY WORSENS WEAKNESS
  • PE = weakness/fatigue confirmed, ptosis
129
Q

Myasthenia Gravis

Diagnostics?

A

clinical= ice pack test (ptosis resolves)
Testing = tensilon testing, EMG, serum ach receptor Ab

130
Q

Myasthenia Gravis

Tx?

A
  • Cholinesterase inhibitors = Pyridostigmine (Mestinon) and monitor for cholinergec sx’s (increased lacrimation, salivation, bradycardia, stomach cramps)
  • weakness persists w/ pyrido? -> prednisone
  • acute/severe weakness? -> Plasma exchange or IVIG
131
Q
A
132
Q
A
133
Q
A
134
Q
A
135
Q
A
136
Q
A
137
Q
A

Clin Med 2 (4 decks)

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