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PANCE/EOC > Neurology #1 > Flashcards

Neurology #1 Flashcards

1
Q

What is the study of choice for evaluating most acute head injuries?

A

CT head without contrast

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2
Q

When is an MRI the study of choice for head injuries?

A

-If prolonged symptoms, > 7-14 days or with worsening symptoms not explained by concussion syndrome

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3
Q

Management of concussion syndrome

A
  • Cognitive and physical rest is main management
  • Observation for 24 hours
  • Resume strenuous activity after resolution of symptoms and recovery of memory
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4
Q

Explain symptoms of a lower motor neuron injury

A
  • Muscles are FLABBY
  • -Flaccid paralysis
  • -Loss of muscle strength and tone
  • -Areflexia (decreased DTR)
  • -Babinski downwards
  • -Young (infantile paralysis)
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5
Q

Conditions that cause lower motor neuron problems (B’s)

A
  • Guillain-Barre Syndrome
  • Botulism
  • Bell Palsy
  • Cauda Equina Syndrome (Back)
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6
Q

Symptoms of upper motor neuron injury

A
  • Muscles are SPASTIC
  • -Slight muscle loss (no atrophy)
  • -Positive Babinski (upward)
  • -Absence of fasciculations
  • -Strong tone
  • -Tone increased
  • -Increased DTR
  • -Clonus
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7
Q

Name the 12 cranial nerves

A 
I: Olfactory
II: Otic
III: Oculomotor
IV: Trochlear
V: Trigeminal
VI: Abducens
VII: Facial
VIII: Vestibulocochlear (Acoustic)
IX: Glossopharyngeal
X: Vagus
XI: Accessory
XII: Hypoglossal
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8
Q

What areas would there be an injury at with the following problems:

1) Loss of triceps jerk
2) Loss of biceps jerk
3) Loss of knee jerk
4) Loss of ankle jerk

A

1) C7-C8
2) C5-C6
3) L3-L4
4) S1-S2

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9
Q

Which nerve would be injured that would lead to a foot drop?

A

Peroneal nerve

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10
Q

MC overall cause of primary headache

A

Tension type headache

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11
Q

Risk factors for a tension headache

A
  • Mental stress
  • Eye strain
  • Sleep deprivation
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12
Q

Describe a tension type headache

A
  • Bilateral, pressing, tightening “band-like” nonpulsatile steady or aching headache, often worsens throughout the day
  • No nausea, vomiting, photophobia, phonophobia, or focal neurological symptoms
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13
Q

Treatment for tension headaches

A
  • NSAIDs and other analgesics
  • Local heat
  • Anti-migraine medications
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14
Q

What levels provide the following motor functions?
____: shoulder abduction, elbow flexion (palm up)
____: elbow flexion (thumb up), wrist extension
____: elbow extension, wrist flexion
____: finger flexion
____: finger abduction

A 
C5
C6
C7
C8
T1
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15
Q

Pathophysiology of Trigeminal Neuralgia (Tic Douloureux)

A

Compression of trigeminal nerve (cranial nerve V) root by superior cerebellar artery or vein

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16
Q

Symptoms of trigeminal neuralgia

A
  • Brief, episodic stabbing or shock-like pain in the 2nd or 3rd division of trigeminal nerve
  • Worse with chewing, brushing teeth, drafts of wind, and movements
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17
Q

First-line treatment for trigeminal neuralgia

A
  • Carbamazepine or Oxcarbazepine

- Surgical decompression for refractory cases

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18
Q

Symptoms of a migraine headache

A
  • Lateralized, pulsatile, throbbing headache associated with nausea, vomiting, photophobia, phonophobia
  • Worsened with physical activity
  • Auras last < 60 minutes (visual)
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19
Q

Treatment for migraines

A
  • NSAIDs, Acetominophen, or Aspirin first line if mild
  • IVF and placing patient in a dark room are helpful
  • Antiemetics (Metoclopramide, Prochlorperazine)
  • Triptans or Ergotamines if severe or no response to above treatment
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20
Q

Side effects of Triptans

A
  • Chest tightness from vasoconstriction
  • Nausea, vomiting, abdominal cramps
  • Flushing, malaise
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21
Q

Antiemetics such as Metoclopramide are ______ receptor antagonists, but have adverse effects such as

A

Dopamine receptor antagonists

-Exprapyramidal symptoms: Dyskinesias, sustained contractions in face, neck, trunk

22
Q

What can you give a patient if they are experiencing dystonic reactions with Metoclopramide?

A

IV Diphenhydramine

23
Q

What kind of medication can be given as prophylactic migraine therapy?

A

BB (Propanolol)

24
Q

Triggers for cluster headaches

A
  • Worse at night
  • Alcohol
  • Stress
  • Ingestion of specific foods
25
Q

Symptoms of a cluster headache

A
  • Severe, unilateral periorbital or temporal pain (sharp)
  • Bouts last < 2 hours with spontaneous remission
  • Several times per day
  • Horner’s Syndrome: ptosis, miosis, anhidrosis, nasal congestion, rhinorrhea, conjunctivitis, rhinorrhea
26
Q

What are the three main symptoms of Horner’s Syndrome?

A

Ptosis, Miosis, Anhidrosis (inability to sweat normally)

27
Q

Acute management of cluster headache

A

100% oxygen via non-rebreather mask

-Sumatriptan can help during acute attack

28
Q

Prophylaxis for cluster headache

A

Verapamil (CCB) is first line

29
Q

What is idiopathic intracranial HTN (Pseudotumor Cerebri)

A

Idiopathic increased intracranial (CSF) pressure with no clear cause evident on neuroimaging

30
Q

Risk factors for Idiopathic Intracranial HTN

A
  • Obese women of childbearing age
  • Meds: growth hormone, OCP, long-term tetracycline use, Vitamin A Toxicity
  • Venous sinus thrombosis
31
Q

Symptoms of Idiopathic Intracranial HTN

A
  • Headache: pulsatile and worse with straining
  • Retrobulbar pain worse with eye movements
  • Nausea, vomiting, tinnitus
  • Visual changes that lead to blindness if not treated
32
Q

On ocular exam for Idiopathic Intracranial HTN, what is seen?

A

Papilledema (bilateral and symmetric)
May have visual field loss
Diplopia due to Abducens nerve palsy

33
Q

Diagnostics for I-I HTN

A
  • CT: performed prior to LP to rule out mass
  • LP: increased CSF Pressure (>250) + otherwise normal CSF
  • MRI with MR venography is the ideal imaging
34
Q

First-line treatment for I-I HTN

A

-Acetazolamide (decreases CSF production) and weight loss recommended

35
Q

Again, what does the CSF show if the patient is positive for Idiopathic Intracranial HTN?

A

Increased opening pressure, otherwise normal CSF

36
Q

MCC of acute bacterial meningitis in adults of all ages and children 3 months - 10 years

A

Strep Pneumo

37
Q

MCC of bacterial meningitis in children 10 years - 19 years

A

Neisseria Menigitidis

38
Q

What is Neisseria Menigitidis associated with?

A

Petechial rash on trunk, legs, and conjunctivae

39
Q

MCC of bacterial meningitis in neonates < 1 month and infants < 3 months and why

A

Group B Strep (S. agalactiae)

-It is part of the vaginal flora

40
Q

Symptoms of bacterial meningitis

A
  • Headache
  • Neck stiffness
  • Photosensitivity
  • Fever
41
Q

What are some physical exam findings of a patient with meningitis?

A
  • Nuchal rigidity
  • Positive Brudzinski (neck flexion produces knee flexion
  • Positive Kernig sign (inability to extend knee/leg with hip flexion)
42
Q

Diagnostics for bacterial meningitis include, and the order they should be done in

A
  • Head CT scan (if you need to rule out mass if papilledema, seizures, confusion, > 60 years old, immunocompromised) should be done first
  • Otherwise, do LP + CSF exam
43
Q

What does an LP with CSF exam show if the patient has bacterial meningitis?

A
  • Increased opening pressure
  • Increased protein
  • Increased neutrophils
  • Turbid appearance
  • Decreased glucose
44
Q

True or False: Antibiotics along with Dexamethasone should be started as quickly as possible after LP or prior to head CT if needed

A

True

45
Q

_____ has been shown to reduce mortality and sequelae of S. Pneumo in meningitis

A

Dexamethasone

46
Q

Treatment for bacterial meningitis for ages > 1 month - 50 years

A

Vancomycin + Ceftriaxone

47
Q

For > 50 years old, what is the treatment for meningitis?

A

Vancomycin + Ceftriaxone + Ampicillin

48
Q

What bacteria is responsible for increased incidence of meningitis in neonates, > 50 years, immunocompromised states (pregnant, AIDS, chemotherapy)

A

Listeria Monocytogenes

49
Q

What medications are options for post-exposure prophylaxis for meningitis if prolonged exposure > 8 hours, or direct exposure to respiratory secretions?

A

Rifampin or Ciprofloxacin

50
Q

What medications are options for post-exposure prophylaxis for meningitis if prolonged exposure > 8 hours, or direct exposure to respiratory secretions?

A

Rifampin or Ciprofloxacin

51
Q

True or False: Prophylaxis is not recommended for health care workers who have not had direct exposure to respiratory secretions?

A

True

PANCE/EOC (63 decks)

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