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Review > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Example of 5HT-1 agonist

A

Sumatriptan (Imitrex)

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2
Q

Sumatriptan is contraindicated with

A

History of CVD

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3
Q

Sumatriptan can interact with

A
  • SSRI/SNRI –> risk of serotonin syndrome

- ergots

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4
Q

Side effects of Sumatriptan

A
  • flushing
  • tingling
  • chest/neck/sinus/jaw discomfort
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5
Q

Ergotamine/caffeine

A
  • Cafergot
  • potent vasoconstrictor
  • do not use with other vasoconstrictors
  • s/e: nausea
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6
Q

Antiemetics for abortive therapy

A
  • Trimethobenzamide (Tigan)

- Metoclopramide (Reglan)

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7
Q

Contraindications to vasoconstricting drugs

A
  • known or suspected CVD
  • Known or suspected CVA and/or TIA
  • HLD
  • males >40
  • menopausal females
  • uncontrolled HTN
  • Complex migraine
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8
Q

New onset headache in a middle/older adult is usually ___

A

secondary

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9
Q

Most common cause of stroke

A

Hemorrhagic

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10
Q

Risk factors for stroke

A
  • HTN
  • afib
  • stimulants (cocaine)
  • aneurysms
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11
Q

TIA resolves within

A

24 hours

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12
Q

Treatment for TIA

A
  • 911

- oxygen asap

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13
Q

long-term treatment for embolic stroke

A
  • anticoagulation with warfarin

- keep INR between 2-3

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14
Q

Long term teatment for hemorrhagic stroke

A

-avoid heparin, coumadin, aspirin

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15
Q

Cluster headache acute treatment

A
  • 100% oxygen at 12 L/minute

- intranasal 4% Lidocaine or intranasal sumatriptan

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16
Q

Cluster headache concerns

A

-may become suicidal

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17
Q

Cluster headache symptoms

A
  • severe “ice-pick”
  • behind one eye and temple
  • tearing, rhinorrhea, ptosis, miosis (Horner’s syndrome)
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18
Q

Horner’s syndrome

A
  • ptosis
  • miosis
  • facial anhidrosis
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19
Q

Gold standard diagnosis for GCA

A

-temporal biopsy

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20
Q

Plan for GCA

A

-STAT referral to optho or ED

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21
Q

First line treatment for GCA

A
  • High dose steroids

- Prednisone 40-60 mg PO daily

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22
Q

Persons with ___ are at high risk for GCA

A

polymylagia rheumatica

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23
Q

Patients with polymyalgia rheumatica present with

A
  • bilateral morning stiffness and aching
  • lasts 30 minutes or longer
  • usually a recent onset
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24
Q

Tension headache presentation

A
  • bandlike bilateral headache
  • dull and constant
  • tensing of neck muscles
  • reports increased life stressors
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25
Q

Tension headache treatment

A
  • NSAIDs,
  • analgesics
  • Combination OTC of analgesics,asa, caffeine
  • stress reduction and relaxation
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26
Q

Rebound headache

A
  • daily headaches
  • irritability, depression, insomnia may be present
  • caused by overuse of abortive medications
  • discontinue or slowly taper
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27
Q

Bacterial meningitis presentation

A
  • acute onset high fever
  • severe headeache
  • stiff neck
  • meningisimus
  • purple-colored petechial rash
  • N/V
  • photophobia
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28
Q

Is bacterial meningitis a reportable disease

A

yes

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29
Q

Romberg test; what system

A

cerebellar system

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30
Q

Romberg test procedure

A

stand with arms/hands straight on each side with feet together
-positive: excessive swaying, falls down, keeps feet apart to keep balance

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31
Q

Tandem gait procedure

A

walk in straight line with heel to toe

-positive: unable to perform tandem walking

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32
Q

Coordination cerebellar tests

A
  • Rapid alternative movements

- heel-to-shin testing

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33
Q

Sensory system cerebellar tests

A
  • vibration sense
  • sharp-dull touch
  • temperature
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34
Q

Stereogenesis

A

ability to recognize familiar objects through sense of touch only

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35
Q

what system does stereogenesis test

A

cerebellar

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36
Q

Graphesthesia

A

ability to identify figures “written” on skin

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37
Q

Motor exam components

A
  • Gait
  • pronator drift
  • gross leg and fine motor movements of hands
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38
Q

Normal reflex

A

+2

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39
Q

Sustained clonus reflex grade

A

+4

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40
Q

No reflex grade

A

0

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41
Q

Positive Babinski reflex

A

toes spread like a fan

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42
Q

Kernig’s sign

A

flex patient’s hips one at a time, then attempt to straighten the leg while keeping hip flexed at 90
-Positive: resistance to straightening because of painful hamstring and/or complains of back pain

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43
Q

Brudzinski’s sign

A
  • passively flex/bend the neck toward’s chest

- Positive: patient reflexively flexes hips and knee to relieve pressure and pain

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44
Q

Nuchal rigidity

A
  • tell patient to touch chest with chin

- positive: unable to touch chest secondary to pain

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45
Q

Offending bacteria for bacterial meningitis

A
  • Streptococcus pneumoniae
  • Neisseria meningitidies
  • Haemophlius influenzae
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46
Q

Labs for bacterial meningitis

A
  • Lumbar puncture: CSF with large WBCs
  • elevated opening pressure
  • CT or MRI
  • gram stain and C&S of CSF before antibiotics
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47
Q

Bacterial meningitis infants medications

A

-ampicillin or 3rd generation ceph

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48
Q

Bacterial meningitis adults medications

A

-3rd generation ceph plus chloramphenicol

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49
Q

Bacterial meningitis >50 medications

A

-amoxicllin plus 3rd gen ceph

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50
Q

Prophylaxis coverage for bacterial meningitis close contacts

A

rifampin

ceftriaxone

51
Q

Complications of bacterial meningitis

A

-patients who recover usually have permanent neurologic sequelae

52
Q

Trigeminal neuralgia aka

A

Tic Douloureux

53
Q

Most common cause of carpal tunnel

A

-repetitive wrist/hand motion

54
Q

Which nerve is compressed in CTS

A

median

55
Q

Risks for CTS

A
  • hypothyroidism
  • pregnancy
  • obesity
56
Q

CTS presentation

A
  • numbness/tingling on thumb, index finger, middle finger areas
  • hand grip weakened
57
Q

Tinel’s sign

A
  • tap anterior wrist briskly

- positive: pins and needles sensation

58
Q

Phalen’s sign

A
  • full flexion of wrist for 60 seconds

- positive: tingling sensation of median nerve

59
Q

Which headache is treated with high-dose anticonvulsants

A

trigeminal neuralgia

60
Q

Only bilateral headache

A

tension

61
Q

Which headache is seen more in middle-aged males

A

cluster

62
Q

Peripheral vertigo

A

involves vestibular system

63
Q

central vertigo

A

involves brainstem or cerebellum

64
Q

Benign paroxysmal vertigo is reproduced by which maneuver

A

Dix-Hallpike

65
Q

Meniere disease characteristics

A
  • recurrent
  • minutes to hours
  • acute onset
  • unilateral decrease/loss inhearing
66
Q

Antihistamin medications for vertigo

A

Meclizine (antivert)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)

67
Q

When to refer vertigo

A

most cases except BPV

68
Q

Patients on ___ are at risk for B12 deficiency

A
  • metformin

- increased after 4 years

69
Q

Rest tremors

A

-occurs when tremulous body part is supported by gravity and not engaged in activity

70
Q

Action tremor

A

occurs when body part is being used

71
Q

Most common rest tremor

A

Parkinson’s disease

72
Q

Cardinal features of Parkinson’s

A
  • rest tremor
  • Bradykinesia
  • rigidity
73
Q

PD treatment

A

MAOI
Doapmine agonists
anticholingergic medications
doapmine replacement

74
Q

MAOI

A

Rasagiline (Azilect)

Selegiline

75
Q

Dopamine agonist

A

Pramipexole (Mirapex)

76
Q

Anticholinergic medications for PD

A

Benztropine mesylate (Cogentin)

77
Q

Dopamine replacement

A

-Carbidopa/levodopa (Sinemet)

78
Q

How is PD diagnosis made

A

assessing response to dopaminergic therapy

79
Q

Most common action tremor

A

essential tremor

80
Q

When is essential tremor more common

A

older age

81
Q

Where does essential tremor occur

A

bilateral action tremor of hands, forearms, head, voice, chin, lip
-leg tremor is unusual

82
Q

Clinical features of essential tremor

A
  • apparent when arms are outstretched
  • more apparent at end of goal-directed movements (glass closer to lips)
  • no other neuro deficits
83
Q

Eessential tremor treatment

A
  • Propanolol

- primidone

84
Q

Dementia diagnostic criteria

A
  • at least 1 cognitive decline in these domains
  • learning and memory
  • language,
  • executive function
  • complex attention
  • perceptual-motor
  • social cognition
  • cognitive deficits must be severe enough to interfere with daily function
85
Q

Most common dementia

A

Alzheimer’s

86
Q

Cognitive testing for dementia

A
  • MMSE

- Montreal Cognitive Assessment (MoCA)

87
Q

Delirium

A

acute onset

88
Q

AD treatment

A
  • acetylcholinesterase inhibitors

- Memantine (Namenda)

89
Q

Acetylcholinesterase inhibitor examples

A
  • donepezil (Aricept)
  • rivastigmine (Exelon)
  • galantamine (Razadyne)
90
Q

Multiple sclerosis patho

A

demyelinating and dysmelinating

  • cause unknown
  • inflammation of nerves
91
Q

MS presentation

A
  • relapse and remissions
  • 15-50 years
  • optic neuritis
  • fatigue
  • bowel and bladder dysfunction
  • cognitive impairment
  • depression
  • eye movement abnormalities
92
Q

Imaging for multiple sclerosis

A

MRI

93
Q

Acute attack of MS treatment

A

-IV methylprednisolone with short prednisone taper

94
Q

CN 1

A

olfactory

95
Q

CN 2

A

optic

-Snellen chart

96
Q

CN 3

A

oculomotor

  • eye movements
  • pupillary constriction
  • accomodation
97
Q

CN 4

A

trochlear

-movement of superior oblique muscle

98
Q

CN 5

A

Trigeminal

  • sensation to face, nasal and buccal mucosa, and teeth
  • motor division for mastication
99
Q

CN 6

A

Abducens

-movement of lateral rectus muscle

100
Q

CN 7

A

Facial

-innervates facial muscles and supplies taste to anterior 2/3 of tongue

101
Q

CN 8

A

Vestibulocochlear

-hearing, balance, position

102
Q

CN 9

A

Glossopharyngeal

-sensation to pharynx, posterior 1/3 of tongue, TM

103
Q

CN 10

A

Vagus

-gag reflex, rise of uvula at midline

104
Q

CN 11

A

Spinal accessory

-motor nerve supplying sternocleidomastoid and trapezius muscles

105
Q

CN 12

A

Hypoglossal

  • Motor fibers to muscles of tongue
  • tongue sticks out at midline
106
Q

What test treats BPPV

A

Epley maneuver

107
Q

Acetylcholinesterase inhibitor mechanism

A

-prevents breakdown of acetylcholinesterase

108
Q

Acetylcholinesterase side effects

A
  • nausea
  • vomiting
  • diarrhea
  • decreased appetite
  • weight loss
  • bradycardia
  • hypotension
109
Q

Vertical diplopia cranial nerve

A

-CN 4

110
Q

Horizontal diplopia cranial nerve

A

CN 6

111
Q

Both vertical and horizontal diplopia

A

CN 3

112
Q

older adult concerned about misplacing items, is it concerning?

A

No, patient is able to self-report memory loss and continue working

113
Q

Best antieplipetic for generalized seizures

A

valproate

114
Q

Valproate serum levels

A

50-100

115
Q

Status epilepticus

A
  • seizure more than 5 minutes

- transfer to ER

116
Q

NMDA receptor antagonist for dementia

A

Memantine

117
Q

Migraine prophylaxis for pregnancy

A

-Riboflavin (B vitamin)

118
Q

Acute angle glaucoma presentation

A
  • one eye with pain
  • blurred vision
  • N/V
  • cornea hazy
  • pupil dilated midway
119
Q

Acute angle glaucoma treatment

A

ED

120
Q

Chronic subdural hematoma

A

-gradual and symptoms may not show until a few weeks after injury

121
Q

Subarachnoid hemorrhage

A
  • severe sudden headache
  • photophobia
  • N/V
  • meningeal irritation (stiff neck, positive Brudzinski, Kernig)
  • sentinal headache: sudden severe ehadache that resolves before major hemorrhage happens
122
Q

Patients who experience TIA are at higher risk for stroke

A

True

up to 20% will have stroke within 90 days

123
Q

First line treatment for trigeminal neuralgia

A

carbamazepine

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