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Internal Medicine > Neurologic > Flashcards

Neurologic Flashcards

1
Q

Bell’s Palsy cause

A

herpes simplex virus; trauma, neoplasia, toxins; frequent in pregnancy, DM

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2
Q

Bell’s Palsy s/s

A

abrupt unilateral facial muscle weakness (mainly right side) progressing over 2 hours; paralysis of forehead, lower face; cannot close eye, raise brow, smile (CN VII); pain of ipsilateral ear precedes; peaks in 21 days, full recover in 6 months

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3
Q

Bell’s Palsy dx

A

clinical; EMG (complicated); r/o stroke, tumors, Lyme disease, AIDS, sarcoidosis w/ CXR/CT/MRI

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4
Q

Bell’s Palsy tx

A

oral prednisone, antiviral; lubricating eye drops

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5
Q

Myasthenia Gravis cause

A

insidious; coincidental infection

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6
Q

Myasthenia Gravis s/s

A

ptosis, diplopia; difficulty chewing/swallowing, respiratory difficulties, limb weakness; normal sensation/reflexes; fluctuate in intensity, longer term spontaneous relapses/remissions

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7
Q

Myasthenia Gravis dx

A

CT/MRI (r/o coexisting thymoma); EMG/repetitive nerve stimulation; serum assay of circulating acetylcholine receptor antibodies (positive); MuSK antibodies (positive); marked clinical improvement after short-acting anticholinesterase (edrophonium)

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8
Q

Myasthenia Gravis tx

A

cholinesterase inhibitor (pyridostigmine); thymectomy; corticosteroids, immunosuppressive, IVIG, plasmapheresis (refractory)

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9
Q

Trigeminal Neuralgia (Tic Douloureax) cause

A

aging, tumor, multiple sclerosis

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10
Q

Trigeminal Neuralgia (Tic Douloureax) s/s

A

brief, unilateral, stabbing facial pain in area of divisions of trigeminal nerve (cheek, jaw, teeth, gums, lips, eye, forehead); pain triggered by touch, movement, eating; normal physical exam normal

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11
Q

Trigeminal Neuralgia (Tic Douloureax) dx

A

neuro exam (reflex exam, determine which part of nerve); MRI

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12
Q

Trigeminal Neuralgia (Tic Douloureax) tx

A

anticonvulsants (Carbamazepine, Phenytoin, topiramate, oxcarbazepine); antispasmodics (baclofen); botox injections; microvascular decompression

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13
Q

Generalized Convulsive Seizures cause

A

idiopathic (5-20yo); secondary (congenital abnormalities, perinatal injury, metabolic disorders, trauma, tumors, vascular disease, infectious disease, degenerative diseases, Alzheimer disease, s/p stroke)

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14
Q

Generalized Convulsive Seizures s/s

A

sudden LOC, convulsive (grand mal or tonic-clonic); postictal obtundation, confusion (last min-hrs); status epilepticus (fail to cease spontaneously or regain consciousness >5 min between seizures)

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15
Q

Generalized Convulsive Seizures dx

A

EEG (normal); r/o metabolic/toxic cause (CBC, glucose, electrolytes, Ca, Mg, LFTs, renal function, syphilis)

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16
Q

Generalized Convulsive Seizures tx

A

carbamazepine, phenytoin, valproic acid (first line); diazepam, lorazepam IV (stop current seizure); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide

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17
Q

Generalized Non-Convulsive Seizures cause

A

idiopathic (5-20yo); secondary (congenital abnormalities, perinatal injury, metabolic disorders, trauma, tumors, vascular disease, infectious disease, degenerative diseases, Alzheimer disease, s/p stroke)

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18
Q

Generalized Non-Convulsive Seizures s/s

A

sudden LOC, non-convulsive (absence); minor motor activity (blinking, facial twitching)

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19
Q

Generalized Non-Convulsive Seizures dx

A

EEG (bilaterally synchronous, symmetric 3-Hz spike and wave activity); r/o metabolic/toxic cause (CBC, glucose, electrolytes, Ca, Mg, LFTs, renal function, syphilis)

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20
Q

Generalized Non-Convulsive Seizures tx

A

valproic acid, ethosuximide

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21
Q

Simple Partial Seizures s/s

A

○ S/S: no LOC; isolated tonic/clonic activity of limb or transient altered sensory perception (Jacksonian march)

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22
Q

Simple Partial Seizures dx

A

EEG (focal rhythmic discharge at onset of seizure, no ictal activity)

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23
Q

Simple Partial Seizures tx

A

carbamazepine, phenytoin, valproic acid (first line); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide

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24
Q

Complex Partial Seizures s/s

A

no LOC; aura (transient abnormalities in sensation, perception, emotion, memory) followed by impaired consciousness lasting sec-min; N/V, focal sensory perceptions, focal tonic/clonic activity

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25
Q

Complex Partial Seizures dx

A

EEG (interictal spikes, spikes associated w/ slow waves in temporal or frontotemporal areas)

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26
Q

Complex Partial Seizures tx

A

carbamazepine, phenytoin, valproic acid (first line); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide

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27
Q

Cluster Headache cause

A

middle aged men; vascular etiology, disturbance of serotonergic mechanisms; triggers (alcohol, stress, foods, glare)

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28
Q

Cluster Headache s/s

A

severe unilateral periorbital pain (occur daily 4-8wks, last 15min-3hrs); ipsilateral nasal congestion, rhinorrhea, lacrimation, eye redness, horner’s syndrome (sympathetic nerve problem); restlessness, agitation

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29
Q

Cluster Headache dx

A

clinical (ipsilateral symptoms); labs/imaging/LP r/o other causes

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30
Q

Cluster Headache tx

A

administer 100% oxygen; sumatriptan; ergotamines, intranasal triptans, analgesics (intranasal butorphanol); prophylactic (verapamil; valproate, lithium, steroids)

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31
Q

Migraine Headache cause

A

family history, menstrual pattern; seizures, essential tremor, Tourette’s syndrome, depression, anxiety, stroke; triggers (chocolate, red wine, MSG, hard cheese, hormones, exertion, nitrites, stress, fatigue)

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32
Q

Migraine Headache s/s

A

unilateral throbbing/pulsating discomfort; N/V, photophobia, phonophobia; aura (visual changes, flashing lights); prefer dark, quiet spaces

33
Q

Migraine Headache dx

A

clinical; labs/imaging/LP to r/o other causes

34
Q

Migraine Headache tx

A

avoid triggers; Reglan + Benadryl; Triptans (abortive); TCAs, b-blockers (preventative)

35
Q

Tension Headache cause

A

stress, fatigue, noise, glare, poor posture, smoking, sleep deprivation, hunger, eye strain; trauma

36
Q

Tension Headache s/s

A

bilateral band-like pain around head, steady, aching, vise-like, tight quality; poor concentration, neck pain; worse at end of day or w/ stress; no neuro deficits, N/V, photophobia, phonophobia

37
Q

Tension Headache dx

A

clinical; pericranial tenderness

38
Q

Tension Headache tx

A

ASA, acetaminophen, NSAIDs; heat, muscle relaxers, PT, relaxation, psych therapy

39
Q

Temporal Arteritis cause

A

large/medium vasculitis; blood vessel inflammation; associated w/ polymyalgia rheumatica

40
Q

Temporal Arteritis s/s

A

new onset headache, abrupt onset of visual disturbance, jaw claudication, unexplained fever/anemia

41
Q

Temporal Arteritis dx

A

temporal artery biopsy; ESR >50; angiography/US/MRI/MRA

42
Q

Temporal Arteritis tx

A

high-dose glucocorticoid steroids (40-60 mg prednisone)

43
Q

Transient Ischemic Attack (TIA) cause

A

carotid or vertebral vascular occlusion

44
Q

Transient Ischemic Attack (TIA) s/s

A

lasts a few min-hour, resolves without intervention; contralateral hand, arm weakness with sensory loss, ipsilateral visual symptoms or aphasia, carotid bruits (carotid); diplopia, ataxia, vertigo, CN palsies, lower extremity weakness, dimness or blurring of vision, perioral numbness and drop attacks (vertebral)

45
Q

Transient Ischemic Attack (TIA) dx

A

CT angiography (definitive study); US doppler; CT head/MRI r/o hemorrhage; cardiac workup w/ echo; PT/PTT

46
Q

Transient Ischemic Attack (TIA) tx

A

prophylactic antiplatelet therapy (ASA, clopidogrel, dipyridamole); heparin w/ warfarin, long term control of BP, glucose, stop smoking and alcohol

47
Q

Cerebrovascular Accident (CVA) cause

A

thrombotic vs embolic vs hemorrhagic; HTN, hypercholesterolemia, atrial fib, DM, oral contraceptive, smoking, alcohol use

48
Q

Cerebrovascular Accident (CVA) s/s

A

abrupt onset; aphasia, apraxia, hemiparesis, hemisensory loss, visual field deficits (anterior); coma, drop attacks, vertigo, N/V, ataxia (posterior); increased ICP, headaches (hemorrhagic)

49
Q

Cerebrovascular Accident (CVA) dx

A

CT head (r/o hemorrhage); MRI; CBC, PT/PTT, ESR, platelet count; LP

50
Q

Cerebrovascular Accident (CVA) tx

A

thrombolytic treatment w/in 3 hours onset; antiplatelet therapy (thrombolytic); HTN management, antiedema therapy w/ mannitol and corticosteroids (hemorrhagic); endovascular repair/surgical clipping; long-term supportive care

51
Q

Syncope cause

A

arrhythmias, aortic stenosis, carotid sinus hypersensitivity, MI, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, PE, vagal faint

52
Q

Syncope s/s

A

sudden transient LOC w/o trauma

53
Q

Syncope dx

A

clinical; EKG, Holter monitor, echo, tilt-table test, CT/MRI

54
Q

Syncope tx

A

varies w/ cause

55
Q

Guillian-Barre Syndrome (acute idiopathic polyneuropathy) cause

A

minor infections of lungs or GI tract (campylobacter, EBV, CMV, HIV), immunizations, surgical procedures

56
Q

Guillian-Barre Syndrome (acute idiopathic polyneuropathy) s/s

A

acute symmetrical extremity weakness (begins distally then ascends, proximal muscles affected more often than distal); DT reflexes decreased absent; CN deficit; sensory abnormalities, pain; tachycardia, cardiac irregularities, disturbed sweating, impaired pulmonary function, sphincter disturbances, paralytic ileus; difficulty swallowing/breathing

57
Q

Guillian-Barre Syndrome (acute idiopathic polyneuropathy) dx

A

electrophysiologic studies (nerve conduction velocities, denervation, axonal loss); CSF (elevated protein, normal WBC)

58
Q

Guillian-Barre Syndrome (acute idiopathic polyneuropathy) tx

A

admit to hospital for ABCs; plasmapheresis, IVIG; PT/OT/ST

59
Q

Meningitis cause

A

group B strep, e. Coli, listeria (neonates); H. influenza, s. Pneumo, n. Meningitidis (infants/children), s. Pneumo, n. Meningitidis, H. influenza, staph (adults)

60
Q

Meningitis s/s

A

headache, AMS, phonophobia, photophobia, neck rigidity/stiffness, high fever, nonblanching petechiae

61
Q

Meningitis dx

A

Kernig’s sign, Brudzinski’s sign, lumbar puncture; blood cultures, CT
■ LP results: high WBC, low glucose, high protein (bacterial); low WBC, high glucose, high protein (viral); low WBC, low glucose, high protein (fungal)

62
Q

Meningitis tx

A

IV abx specific to organism (Vancomycin + Ceftriaxone, ampicillin), corticosteroids (dexamethasone), IV hydration

63
Q

Multiple Sclerosis cause

A

immunologic disorder associated w/ CNS immunoglobulin production and alteration of T lymphocytes; viral infection; genetic (HLA, HLA-DR2)

64
Q

Multiple Sclerosis s/s

A

sensory complaints and vision loss; focal weakness, numbness/tingling, optic neuritis, blindness, blurry vision, diplopia, focal neuralgias, balance problems, fatigue, urinary symptoms; last days-weeks, relapsing-remitting pattern

65
Q

Multiple Sclerosis dx

A

McDonald criteria (attacks vs lesions); lab studies (underlying disease); MRI (white matter lesions in CNS); CSF (inflammation, mild elevated WBC or protein, elevated immunoglobulin G index, oligoclonal bands, increased myelin basic protein); visual, auditory, somatosensory evoked potentials

66
Q

Multiple Sclerosis tx

A

high-dose IV corticosteroids (optic neuritis); plasma exchange (acute); interferon-b or subQ glatiramer acetate (prevent relapse); immunosuppressive (cyclophosphamide, azathioprine); amantadine, pemoline (fatigue); baclofen, diazepam (spasticity); anticholinergics/oxybutynin (urologic symptoms)

67
Q

Parkinson’s Disease cause

A

idiopathic; deficiency in dopamine; imbalance of dopamine and acetylcholine

68
Q

Parkinson’s Disease s/s

A

: “pill rolling” tremor; slowed movements, difficulty arising from seated position, difficulty ascending and descending stairs, trouble getting dressed, difficulty w/ hand writing; tremor in limbs, mouth, lips; shuffling gait, infrequent blinking, masklike facies; cogwheel rigidity, increased resistance to passive motion; depression/cognitive impairment

69
Q

Parkinson’s Disease dx

A

resting tremor, bradykinesia, rigidity, postural instability; blood/imaging r/o other causes

70
Q

Parkinson’s Disease tx

A

anticholinergic (amantadine) + Levodopa (precursor of dopamine); Levodopa/Carbidopa (ADEs: N/V, hypotension, somnolence); Dopamine agonist/Bromocriptine (ADEs: orthostatic hypotension, nausea, HA); Sergeline (MOBI) and tolcapone, entacapone (COMT)

71
Q

Alzheimer’s Disease cause

A

older age, genetic (chromosomes 1, 14, 19, 21), lower education level, female gender

72
Q

Alzheimer’s Disease s/s

A

otherwise alert pt exhibits progressive memory loss and cognitive deficits such as disorientation, language difficulties, inability to perform complex motor activities, inattention, visual misperception, poor problem-solving abilities, inappropriate social behavior, hallucinations

73
Q

Alzheimer’s Disease dx

A

intracellular neurofibrillary tangles, extracellular neuritic plaques; CBC, heavy metal screens CMP, Ca, glucose, TSH, vit B12, renal/LFTs, etoh, drug screen (r/o other causes)

74
Q

Alzheimer’s Disease tx

A

anti aging*) acetylcholinesterase inhibitors (tacrine, donepezil, galantamine, rivastigimine); NMDA receptor agonists; daycares

75
Q

Encephalopathy cause

A

alcohol, thiamine/B1 deficiency (Wernicke-Korsakoff); AIDS, cancer, renal dialysis, hyperthyroidism; anoxic/hypoxic; hypertension; infectious (encephalitis, meningitis)

76
Q

Encephalopathy s/s

A

decreased levels of consciousness, minimal lethargy, coma, confusion, poor memory, hallucinations, psychotic thinking; may mimic stroke with unilateral weakness, facial droop, and speech problems

77
Q

Encephalopathy dx

A

clinical; CBC (infection, anemia, B12 deficiency); CMP (electrolytes, glucose, liver function); CT/MRI/Xray; LP (infection, inflammation)

78
Q

Encephalopathy tx

A

treat underlying cause; oxygen, dialysis or kidney transplant, antibiotics, etc

Internal Medicine (9 decks)

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