Neurology

Question 1

if there is hyperreflexia it’s a problem with:

Answer 1

upper motor neurons: thereofre, problem in BRAIN, spinal cord or anterior (ventral) horn cell.
- similarly, diminished reflexes mean it is a peripheral nervous system problem (unless it’s an acute stroke or spinal cord lesion)

Question 2

Note from lecture: a new headache in someone who is 65 is probably a bad thing. Think hard before putting migraine into this option.

Question 3

72yo M because of headahces which is new for him.

Question 4

6 red flags of headache

Answer 4

systemic symptoms
neuro deficit/signs
older age
onset rapid
progressive tempo: getting worse over time.
pressure: signs of raised ICP.

Question 5

worse when lying down. worse in morning with blurry vision. better when walking up and about. wooshing sound in ear. whatre you worried about?

Answer 5

increased ICP–mass effect, idiopathic inracranial hypertension, bleed or neoplasm, flow obstruction via meningitis or hydrocephalus. Would see papilledema possibly, vomiting, localizing headache

Do CT, MRI brain including venous structures, LP once mass was ruled out to prevent herniation.

Question 6

when a headache is worse standing up, we think of __ pressure

Answer 6

low pressure playing a role in heaache generation– most common is spontaneous intracranial hypotension usually from CSF leak from bony protrusion. Sometimes can see cerebellar tonsil herniation.

Question 7

4321 SULTANS migraine

Answer 7

5 attacks
4hrs-3 days
unilateral
throbbing or pulsaltile
moderate or severe
photophobia/phonophobia
nausea/vomiting.

Question 8

medical treatments for migraines

Answer 8

acute: analgesics, triptans, plus antiemetics
preventative: amitriptyline, riboflavin, magnesium, propanolol, topiramate, candesartan, botox (chronic ONLY 15+ migraine days a month)

Question 9

medication overuse headache

Answer 9

headahce brought on by simple analgesics (advil, tylenol), use of tylenol more than 15days a month can cause overuse headache.
Need a preventative and transition to different analgesic/management.

Question 10

prodrome syncope

Answer 10

warm flush
sweaty
spots in eyes
rushing sound in ears
claminess
palpation
no post ictal period.

Question 11

prodrome of seizure

Answer 11

can be confused or agitation or having auroa,. bright lights flashing. Higher likelyhood of loss of continence or tongue biting. Usually takes 30+ minutes to return to basline (post ictal phase)

Question 12

defintiion of epilepsy

Answer 12

at least two unprovoked seizures occurring more than 24 hours apart. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures.

Question 13

defintiion of epilepsy

Answer 13

at least two unprovoked seizures occurring more than 24 hours apart. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures.

Question 14

status epilepticus

Answer 14

two seizures without return to baseline lasting minutes or longer.

Question 15

reduced rhomberg, paresthesia, reduced balance

Answer 15

B12 deficiency
idiopathic neuropathy
diabetic neuropathy
monoclonal gammopathy
syphillis

these are Larger nerve neuropathies

Question 16

Type of med to use when you noticed clot stroke

Answer 16

tpa can be used 4.5 since onset of CVA. Or cath lab endovascular therapy up to 6 hours. avoid lowering the BP if normal. Don’t start aspirin immediately.

Repeat CT in 24 hours to rule out hemorrhage after administering TPA. Start aspirin only after repeat CT. IV normal saline 74cc/hr

long term anticoagulation and assess clot workup (look at heart echo, holter, lipid panel, a1c, hb, coag panels)

Question 17

TPA contraindications

Answer 17

Active brain bleed or active hemorrhage whil stroking out.

relative contraindications: prev bleed stroke, major surgery in the las 14 days. arterial puncture at a non-compressible site in the previous seven days. INR high.

Question 18

epidural hemorrhage

Answer 18

middle meningeal artery. first normal than an hour later is unconcious. Lemon shaped

Question 19

subdural hemorrhage

Answer 19

bridging vein hemorrhage. Can be deeper and then seen in older people. Banana shaped.

Question 20

subarachnoid hemorrhage

Answer 20

can see in basal cistern or in sulci. Aneurysmal rupture is most common cause of subarachnoid hemorrhage (check for kidney disease)

Question 21

diagnosing MS

Answer 21

two different lesions in two different parts, or 2 events in different times (two bouts of optic neuritis)