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EOR - Emergency Medicine > Neurology > Flashcards

Neurology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

3 broad pathological causes of AMS

A

systemic infxn
metabolic dysfxn
vascular events

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2
Q

what tx can be diagnostic and therapeutic for a common drug related cause of AMS

A

naloxone

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3
Q

general tx for AMS

A
  1. ABCs
  2. BG
  3. thiamine plus dextrose
  4. +/- naloxone
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4
Q

abrupt and transient LOC caused by cerebral hypoperfusion

A

syncope

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5
Q

t/f: all syncope needs full work up

A

t!

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6
Q

5 causes of syncope

A

CVD/structural heart dz
arrhythmia
hypovolemia
orthostatic hypotn
sz

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7
Q

general management of syncope

A

cardiac monitoring
CT
obs

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8
Q

glasgow coma scale

A
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9
Q

3 causes of numbness/paresthesia

A

DM
nerve root pathology
CNS pathology

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10
Q

abnormal dermal sensation due to compromised nerve fxn

A

paresthesia

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11
Q

a pt may describe paresthesia as (5)

A

prickling
tingling
itching
burning
cold skin

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12
Q

work up for paresthesia in the emergency setting must include

A

brain CT vs MRI

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13
Q

sudden onset unilateral facial nerve paralysis w. no other focal neuro/systemic findings

A

bell’s palsy

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14
Q

60% of bells palsy cases involve a _ prodrome,
and symptoms peak in _ hr

A

viral
48

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15
Q

how do differentiate bells palsy vs CVA

A

bells palsy does not spare the forehead

if they can raise their eyebrows, so should you

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16
Q

mc cause of bells palsy

A

HSV

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17
Q

tx for bells palsy

A

prednisone
artificial tears
eye patch

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18
Q

bilateral bells palsy makes you think of (2)

A

lyme dz
mono

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19
Q

common presentations of encephalitis (4)

A

AMS
sz
personality changes
exanthema

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20
Q

encephalitis is differentiated from meningitis by

A

altered brain functioning

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21
Q

mc cause of encephalitis

A

HSV
immunocompromised: CMV

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22
Q

rapidly progressive encephalopathy w. hepatic dysfxn that is usually post flu/URI

A

reye’s syndrome

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23
Q

2 PE findings of reye’s syndrome

A

positive babinski
hyperreflexia

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24
Q

2 pharm causes of reye’s syndrome

A

ASA
pepto

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25
Q

lab findings of reye’s syndrome

A

elevated:
LFTs
PTT
NH3

hypoglycemia
metabolic acidosis

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26
Q

tx for reye’s syndrome

A

supportive
IV acyclovir asap
+/- abx til meningitis is ruled out

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27
Q

sx of reye’s syndrome

A

fever
HA
AMS
personality changes
sz
exanthema

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28
Q

what is exanthema

A

a skin rash accompanying a dz or fever

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29
Q

dx for reye’s syndrome

A

LP
MRI
PCR

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30
Q

2 types of sz in ED setting

A

status epilepticus
focal sz

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31
Q

what is status epilepticus

A

sx >/= 5 min continuous
OR
more than one sz w.o recovery from postictal state

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32
Q

always check _ when pt presents w. sz

A

finger stick BG

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33
Q

tx if pt on TB meds presents w. sz

A

B6 for INH toxicity

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34
Q

mc cause of sz in emergency setting

A

change in meds of someone w. sz d.o

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35
Q

emergent management of sz

A

-place in lateral decubitus position
-IV benzos/phenytoin/phenobarbital/lacosamide
-correct acidosis

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36
Q

sz lasting > _ min may result in permanent brain damage

A

60

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37
Q

types of focal sz

A

-simple partial (retained awareness)
-complex partial (loss of awareness)

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38
Q

tx for focal sz

A

phenytoin
vs
carbamazepine

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39
Q

types of generalized sz (9)

A

absence (petit mal)
tonic-clonic (grand mal)
atonic
clonic
tonic
myoclonic
febrile
infantile spasm
psychogenic nonepileptic

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40
Q

-brief mental status change w.o motor activity
-no aura, post ictal state, or loss of postural tone

A

absence sz

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41
Q

absene sz is mc in what pt pop

A

5-10 yo

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42
Q

EEG findings of absence sz

A

brief 3 Hz spike and wave discharge

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43
Q

tx for absence sz

A

ethosuximide

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44
Q

-convulsive bilaterally symmetric sz w.o focal onset
-begins w. LOC

A

tonic-clonic sz

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45
Q

describe the phases of tonic clonic sz

A

tonic: stiff/rigid 10-60 sec
clonic: convulsions
post ictal: confused

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46
Q

drop attack (similar to syncope)
loss of muscle tone

A

atonic sz

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47
Q

-loss of control of bodily fxn - jerking
+/- LOC

A

clonic sz

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48
Q

extreme rigidity followed by LOC

A

tonic sz

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49
Q

muscle jerking, no tonic phase
occurs early in the AM

A

myoclonic sz

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50
Q

parameters for febrile sz (3)

A

temp > 38
> 6 mo, < 5 yo
absence of CNS infxn/inflammation

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51
Q

infantile spasm is a type of _ sz

A

epileptic

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52
Q

what sz is not due to epilepsy but presents similar to an epileptic sz

A

psychogenic non epileptic

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53
Q

work up for focal/generalized sz

A

check lytes/BG
pregnancy test
ECG/EEG

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54
Q

adults w. first seizure have bought themselves

A

CT/MRI

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55
Q

8 common causes of sz

A

lytes disturbance
infxn
toxic ingestion
trauma
azotemia
hypoxia
hypoglycemia
stroke/bleed

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56
Q

5 meds used for focal sz

A

phenytoin
phenobarb
valproate
lamotrigine
gabapentin

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57
Q

2 types of hematoma

A

epidural
subdural

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58
Q

27 yo, mountain bike vs tree, no helmet - admits to LOC but now feels fine - several hr later he decompensates quickly

A

epidural hematoma

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59
Q

progression of epidural hematoma

A

transient LOC -> lucid -> HA -> unilateral/contralateral weakness

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60
Q

cause of epidural hematoma

A

trauma to skull -> blood between dura and skull

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61
Q

artery mc involved w. epidural hematoma

A

middle meningeal

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62
Q

imaging for epidural hematoma and hallmark finding

A

-non contrast CT
-lenticular, unilateral convexity -> lens shape/lemon in temporal region

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63
Q

tx for epidural hematoma (4)

A

surgical craniotomy
mannitol, steroids
hyperventilate
ventricular shunt

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64
Q

73 yo M w. hx afib on warfarin - presents after fall w. syncope - quickly becomes unconscious

A

subdural hematoma

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65
Q

mc pt pop affected by subdural hematoma

A

elderly and alcoholics: fall -> tear bridging veins

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66
Q

classifications of subdural hematoma

A

acute: 48 hr
subacute: 3-14 days
chronic: > 2 weeks

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67
Q

w. subdural hematomas, blood collects between the _ and _

A

dura and arachnoid mater

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68
Q

dx for subdural hematoma and hallmark finding

A

non contrast CT
crescent shaped concave hyperdensity

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69
Q

tx for subdural hematoma, small vs severe

A

small: obs
severe: surgery -> burr hole vs trephination, craniotomy vs craniectomy

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70
Q

what is this showing

A

epidural hematoma

epi = pie, lemon pie

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71
Q

what is this showing

A

subdural hematoma

sub = b = banana

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72
Q

mc causes of spinal cord injury

A

trauma
disease

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73
Q

classifications of spinal cord injury (4)

A

anterior cord syndrome
central cord syndrome
complete cord transection
brown-sequard (hemisection)

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74
Q

-loss of pain/temp below the level of the lesion
-preserved position/vibration/touch

A

anterior cord syndrome

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75
Q

-loss of pain and temp sensation at the level of the lesion

A

central cord syndrome

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76
Q

-complete loss of movement and sensation below the level of injury
-urinary retention, distended bladder

A

complete cord transection

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77
Q

-loss of proprioception and vibration on teh same side as the lesion
-loss of pain/temp on the opposite side a few levels below the lesion

A

brown-sequard (hemisection)

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78
Q

-ascending paralysis beginning in distal limbs/leg weakness -> total paralysis of all 4 limbs, facial muscles, eyes, reflexes

A

guillain-barre

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79
Q

2 causes of guillain barre

A

-post immunization
-post infectious

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80
Q

infxn mc associated w. guillain barre

A

**campylobacter jejuni **

also CMV, EBV, HIV

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81
Q

dx and tx for guillain barre

A

dx: LP
tx: plasma excange PLUS IVIG

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82
Q

LP findings of guillain barre (2)

A

elevated protein
normal WBC

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83
Q

2 forms of status epilepticus

A

convulsive
nonconvulsive

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84
Q

sz characterized by regular pattern of contraction and extension of arms and legs

A

convulsive status epilepticus

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85
Q

2 types of nonconvulsive status epilepticus

A

complex partial
absence

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86
Q

tx for status epilepticus

A
  1. benzos
  2. phenytoin
87
Q

transient, traumatic brain dysfxn

A

concussion

88
Q

6 sx of concussion

A

confusion
memory loss
LOC
HA
dizzy
n/v

89
Q

concussion and _ are synonymous

A

mild TBI/mTBI

90
Q

mTBI definition

A

-GCS 13-15 30 min post injury
-consciousness loss < 30 min
-post-traumatic amnesia < 24 hr OR other transient neuro abnormality (sz, focal deficits)

91
Q

t/f: all pediatrics with mTBI need brain imaging

A

f!

92
Q

what tool is used to determine who needs CT in peds >/= 2 yo w. mTBI

A

pecarn

93
Q

what peds >/= 2 yo w. mTBI probs don’t need imaging

A

normal mental status
no LOC
no vomiting
non severe MOI
no skull fx
no HA

94
Q

tx for mTBI

A

-2-3 days of brain rest followed by gradual reintroduction of activity that does not worsen sx
-monitor for sx
-APAP/ibuprofen
-limit caffeine

95
Q

when can kiddos return to sport after mTBI

A

only when full recovery is evident

96
Q

2 types of stroke

A

ischemic - mc
hemorrhagic

97
Q

2 types of ischemic stroke

A

thrombotic
embolic

98
Q

-clot develops in the blood vessels inside the brain
-usually preceded by TIA

A

thrombotic stroke

99
Q

-clot develops somewhere outside the brain
-occurs abruptly/w.o warning

A

embolic stroke

100
Q

2 mc locations for embolic stroke to develop

A

aortic arch
large cerebral arteries

101
Q

hemorrhagic strokes are mc due to

A

HTN

102
Q

sx of hemorrhagic stroke

A

hemiparesis
hemisensory deficit

present on one side only
present on side of body opposite stroke

103
Q

types of hemorrhagic stroke (8)

A

anterior
posterior
carotid/ophthalmic
MCA
ACA
PCA
basilar
lacunar

104
Q

what arteries are involved w. anterior stroke

A

anterior cerebral
middle cerebral

105
Q

sx of anterior stroke

A

aphasia
apraxia
hemiparesis
hemisensory loss
visual field defect

106
Q

what arteries are involved w. posterior stroke

A

posterior cerebral
vertebral
basilar

107
Q

sx of posterior stroke

A

coma
drop attack
vertigo
n/v
ataxia

108
Q

what is drop attack

A

sudden fall w.o warning
+/- LOC or neuro sx

109
Q

amaurosis fugax is associated w. aneurysm of what arteries (2)

A

carotid
ophthalmic

110
Q

aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia

A

MCA stroke

111
Q

leg paresis, hemiplegia, urinary incontinence

A

ACA stroke

112
Q

coma, cranial n palsy, apnea, drop attack, vertigo

A

basilar a stroke

113
Q

silent stroke
pure memory OR sensory

A

lacunar stroke

114
Q

dx for stroke

A

noncontrast CT

transcranial doppler
ecoh for ischemic

115
Q

tPA must be administered w.in _ hr of stroke sx onset

A

3-4.5

116
Q

management of pt on tPA

A

-neuro exam:
-q 15 min during infusion
-q 60 min for the next 6 hr
-q 24 hr after tx

-serial BP

117
Q

tPA exclusion criteria

A

-SAH
-head trauma
-prior stroke w.in past 3 mo
-MI w.in past 3 mo
-GI ulcer w.in last 3 mo
-major surgery in last 2 weeks
-hx ICH
-SBP > 185, DBP > 110
-active bleeding
-INR > 1.7 w. anticoagulation
-BG < 50
-sz w. postictal state
-multilobar infarct on CT

118
Q

BP management for stroke pt

A

-hold antihypertensives until SBP > 220 OR DBP > 120
-goal: lower BP 15% in first 24 hr

119
Q

for tPA to be administered, BP has to be _

A

< 185/110

120
Q

how is BP lowered for stroke pt prior to tPA

A

IV labetalol 10-20 mg over 1-2 min

121
Q

3 types of HA

A

cluster
tension
migraine

122
Q

-which type of HA is always unilateral but side can vary
-mc in men

A

cluster

123
Q

describe the pain w. cluster HA

A

excruciating
unilateral

124
Q

sx of cluster HA (besides HA)

A

autononic:
ptosis
miosis
lacrimation
conjunctival injxn
nasal congestion

125
Q

tx for cluster HA

A

100% O2
sumatriptan
prophylaxis: CCB

126
Q

mc type of HA

A

tension

127
Q

describe tension HA pain

A

bilateral
non pulsating
bandlike - frontal/occipital
neck muscle tenderness

128
Q

4 common triggers for tension HA

A

stress
fatigue
glare
noise

129
Q

tx for tension HA

A

NSAIDs
smoking cessation

130
Q

5 common triggers for migraines

A

menstruation
pregnancy
contraceptives
chocolate/cheese/nitrites
etoh

131
Q

describe migraine pain

A

mc unilateral
gradual onset
throbbing/pulsating

132
Q

2 types of migraine

A

w. aura
w.o aura - mc

133
Q

sx of migraine w. vs w.o aura

A

w. aura: scotoma (blind spot), flashing lights, sound

w.o aura: n.v, photophobia, phonophobia

134
Q

mc type of migraine aura

A

visual

135
Q

migrained follows aura w.in _ min

A

30

136
Q

abortive vs prophylactic tx for migraines

A

abortive: triptans, dihydroergotamines (DHE), antiemetics, NSAIDs

prophylaxis: bb, ccb, TCAs

137
Q

2 types of brain hemorrhage

A
138
Q

“worst HA of my life”

A

SAH

139
Q

sx of SAH

A

sudden, severe HA
LOC - 50% of pt
elevated BP
+/- fever

140
Q

less severe but atypical HA that precedes SAH in 40% of pt’s

A

herald bleed

141
Q

mc type of nontraumatic SAH aneurysm

A

berry (saccular)

142
Q

4 rf for SAH

A

smoking
HTN
hypercholesterolemia
heavy etoh

143
Q

dx for SAH

A

non contrast CT
LP

144
Q

LP findings of SAH

A

elevated opening pressure/grossly bloody fluid in all 4 tubes

145
Q

tx for SAH

A

surgical clipping/wrapping
anticonvulsants

146
Q

-abrupt focal neuro deficit that worsens steadily over 30-90 min
-HA, LOC, stupor, coma, vomiting

A

intracerebral hemorrhage

147
Q

mc cause of ICH

A

HTN -> sudden increase in BP -> ruptured parenchyma

148
Q

saccular aneurysms are almost always due to

A

hereditary malformation/weakness in BV of COW

149
Q

mc cause of syncope

A

insufficient cerebral blood flow:
decreased CO or venous return

150
Q

2 mc cause of syncope

A

vasovagal
idiopathic

151
Q

6 red flags w. syncope

A

during exertion
multiple recurrences in short time
heart murmur
old age
significant injury during event
fam hx sudden/unexpected death

152
Q

3 causes of acute loss of coordination/ataxia

A

infarction
edema
hemorrhage

153
Q

when you see loss of coordination/ataxia, think _ involvement

A

cerebellar

154
Q

common cause of chronic/progressive loss of coordination/ataxia

A

parkinsons

155
Q

imaging for ataxia

A

MRI/CT w. AND w.o contrast

156
Q

causes of ataxia

A

drugs/toxins
tumor
CVA
genetics
eustachian tube dysfxn
MS
stroke
huntington
fibromyalgia
metabolic disorders

157
Q

transient episode of neuro dysfxn due to focal brain, retinal, or spinal cord ischemia w.o acute infarction

A

TIA

158
Q

TIA lasts _ on average
and must last < _ by definition

A

-average: 15-30 min
-must last < 60 min, with reversal of sx w.in 24 hr

159
Q

10% of TIA pt’s will have a stroke w.in _ days

A

90

160
Q

imaging for TIA

A

**CT w.o contrast **

carotid doppler US: looks for stenosis
CTA/MRA

161
Q

carotid endarterectomy is indicated if common carotid artery stenosis is _

A

> 70%

162
Q

pharm for for TIA

A

ASA + dipyridamole
OR
clopidogrel

163
Q

_ criteria predicts likelihood of stroke w.in 2 days

A

ABCD2:

164
Q

when is risk for CVA greatest after a TIA

A

24 hr after initial event

165
Q

3 causes of memory loss

A

dementia
delirium
amnesia

166
Q

mc cause of dementia after age 65

A

alzheimers

167
Q

sudden, reversible change in mental status

A

delirium

168
Q

3 common causes of delirium

A

medical conditions:
withdrawal from etoh/drugs/medicines
infxn/sepsis
sunstroke

169
Q

4 common causes of amnesia

A

head injury
CVA
substance use
emotional event

170
Q

criteria for delirium

A

-disturbed level of consciousness (attention/awareness)
-cognitive change (memory, disorientation, language, hallucinations)
-rapid onset (days-hr)
-evidence of a causal physical condition

171
Q

sx of alzheimer’s

A

-progresive memory loss
-difficulty word finding
-concentration problems
-emotional lability
-personality changes
-social withdrawal
-difficulty w. ADLs

172
Q

2 mc types of dementia

A

alzheimer
vascular
lewy body
frontotemporal
neurodgenerative conditions

173
Q

dx tool for dementia

A

folstein MMSE
memory impairment screen

174
Q

2 early signs of alzheimers

A

language deficits
visuospatial deficits

175
Q

5 rf for vascular dementia

A

HTN
dyslipidemia
DM
smoking
old age

176
Q

what dementia is characterized by cognitive fluctuations, visual hallucinations, and parkinsonism

A

lewy body

177
Q

what dementia is characterized by personality/social behavior changes and non-fluent speech

A

frontotemporal dementia

178
Q

what neurodegenerative condition can cause dementia

A

huntington

179
Q

6 reversible causes of dementia

A

B12 deficiency
syphilis
hypothyroidism
NPH
drugs
intracranial mass

180
Q

2 drugs that may slow the progression of dementia

A

donepezil - cholinesterase inhibitor
memantine - NMDA agonist

181
Q

sensation of movement in the absence of movement

A

vertigo

182
Q

2 types of vertigo

A

peripheral
central

183
Q

peripheral vertigo is _ dysfxn
central vertigo is _ dysfxn

A

peripheral: inner ear
central: brainstem

184
Q

5 causes of peripheral vertigo

A

labyrinthitis
BPPV
meniere
vestibular neuritis
head injury

185
Q

peripheral vertigo is characterized by (5)

A

sudden onset
n/v
tinnitus
hearing loss
horizontal nystagmus

186
Q

5 causes of central vertigo

A

brainstem vascular dz
AVM
tumor
MS
vertebrobasilar migraine

187
Q

central vertigo is characterized by (3)

A

gradual onset
vertical nystagmus
no auditory sx

188
Q

vertigo + syncope =

A

vertebrobasilar insufficiency

189
Q

positional vertigo w. no hearing loss, tinnitus, or ataxia

A

BPPV

190
Q

dx and tx for BPPV

A

dx: dix hallpike
tx: epley, meclizine

191
Q

non positional vertigo w.o hearing loss/tinnitus

A

vestibular neuritis

192
Q

tx for vestibular neuritis

A

meclizine

193
Q

acute, self resolving vertigo w. hearing loss

A

labyrinthitis

194
Q

tx for labyrinthitis

A

meclizine
+
steroids

195
Q

chronic, progressive, relapsing vertigo w. hearing loss/tinnitus

A

meniere’s dz

196
Q

tx for meniere’s

A

diuretics
salt restriction
severe: CN VIII ablation

197
Q

vertigo from trauma

A

perilymph fistula

198
Q

tx for perilymph fistula

A

surgery

199
Q

vertigo w. ataxia, hearing loss, tinnitus
neurofibromatosis type II

A

acoustic neuroma

200
Q

meningitis triad

A

fever > 38
nuchal rigidity
HA

201
Q

how is meningitis differentiated from encephalopathy

A

no AMS w. meningitis

202
Q

kernig:
brudzinski:

A

kernig: neck pain w. knee extension
brudzinski: leg raise to compensate for pain w. neck bending

203
Q

2 types of meningitis

A

aseptic: mc viral
bacterial

204
Q

mc cause of bacterial meningitis

A

strep pneumo
gram positive cocci

205
Q

meningitis w. a rash should make you think

A

n. meningitidis
gram negative diplococci

206
Q

2 pathogens associated w. meningitis in neonates

A

e.coli
s.agalactiae

207
Q

2 pathogens associated w. meningitis in pt’s >50-60 yo

A

listeria
cryptococcus neoformans

208
Q

pathogen associated w. HAP meningitis

A

staph

209
Q

dx for meningitis

A
  1. check for ICP/papilledema (CT if unsure)
  2. LP
210
Q

LP findings of bacterial vs aseptic meningitis

A

aseptic: normal pressure, lymphocytosis

bacterial: increased opening pressure and protein, decreased glucose
think bacteria like to eat glucose

211
Q

tx for meningitis: aseptic vs bacterial vs household contacts

A

aseptic: symptomatic vs IV acyclovir if HSV
bacterial: dexamethasone, empiric IV abx
household contacts: rifampin, cipro, levaquin, azithromycin, ceftriaxone

212
Q

abx for step pneumo meningitis

A

ceftriaxone
cefotaxime
vanco
pen g

213
Q
A

EOR - Emergency Medicine (13 decks)

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