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EOR - Internal Med > Neurology > Flashcards

Neurology Flashcards

1
Q

possible viral etiology for bells palsy

A

HSV

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2
Q

common preceding event for bells palsy

A

URI

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3
Q

hallmark presentation of bells palsy

A

-sudden onset of unilateral facial weakness/paralysis of upper and lower parts of the face
-unable to wrinke forehad and close one eye

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4
Q

how to differentiate bells palsy from stroke

A

stroke: pt can wrinkle forehad
bells palsy: forehead paralysis

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5
Q

consider _ dz with bells palsy pt’s
do NOT use _ if you suspect lyme dz

A

lyme
steroids

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6
Q

consider _ testing if bells palsy does not resolve w/in 10 days

A

EMG

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7
Q

tx for bells palsy

A

mc self resolves by 1 month
acute: steroids + acyclovir
nighttime eye patch to prevent corneal abrasion
surgical decompression of CN VII if paralysis progresses

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8
Q

47 yo in ED w. stiff neck, photophobia, severe HA that begin while she was gardening - she is in severe distress

A

cerebral aneurysm

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9
Q

pathophys of cerebral aneurysm

A

weak/bulging spot in wall of brain artery

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10
Q

classification of cerebral aneurysm based on diameter

A

small: <15 mm
large: 15-25 mm
giant: 25-50 mm
supergiant: > 50 mm

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11
Q

types of cerebral aneurysm

A

saccular (berry) - mc
fusiform
traumatic
mycotic
ruptured (AVM)

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12
Q

2 mc locations for saccular/berry aneurysms

A
  1. ACA
  2. ICA
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13
Q

mcc of SAH

A

berry aneurysm

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14
Q

dilation of the entire circumference of the BV

A

fusiform aneurysm

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15
Q

what type of cerebral aneurysm is caused by infected emboli

A

mycotic

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16
Q

6 rf for ruptured cerebral aneurysm

A

smoking
HTN
hypercholesterolemia
heavy etoh
polycystic kidney dz
coarctation of aorta

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17
Q

6 sx of ruptured cerebral aneurysm

A

sudden onset worst HA of life
n/v
sz
AMS
HTN
fever

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18
Q

less severe HA that precedes ruptured cerebral aneurysm

A

herald bleed

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19
Q

dx for cerebral aneurysm

A

gs: cerebral angiography
initial: non contrast head CT
LP

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20
Q

2 LP findings of ruptured cerebral aneurysm

A

elevated opening pressure
bloody fluid (xanthochromia) in all tubes

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21
Q

tx for cerebral aneurysm

A

surgical clipping vs endovascular coiling

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22
Q

2 types of CVA

A

ischemic - blockage
hemorrhagic - rupture

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23
Q

mc sx of CVA

A

contralateral paralysis

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24
Q

occular sx of CVA

A

amaurosis fugax (monocular blindness)

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25
4 sx of MCA CVA
aphasia hemiparesis gaze preference homonymous hemianopsia
26
3 sx of ACA CVA
leg paresis hemiplegia urinary incontinence
27
hallmark sx of PCA CVA
homonymous hemianopsia
28
5 sx of basilar artery CVA
coma cranial n palsies apnea drop attack vertico
29
what are lacunar infarcts
CVA in areas supplied by small perforating vessels
30
3 sx of lacunar infarcts
pure motor or sensory sx dysarthria/clumsy hand syndrome ataxic hemiparesis
31
3 rf for lacunar stroke
atherosclerosis HTN DM
32
initial imaging for CVA
CT w.o contrast
33
management of occlusive CVA's
occlusive: IV tPA w.in 3-4.5 hr of sx onset
34
indication for endarterectomy
carotid a > 70% occluded
35
absolute contraindications to tPA (9)
-hemorrhagic stroke on CT -hx of ICH -sx of SAH -neurosurgery, head trauma, or stroke in past 3 mos -uncontrolled HTN (SBP > 185, DBP > 110) -known AVM, neoplasm, or aneurysm -active internal bleeding -known bleeding diathesis (PLT<100,000, heparin w.in past 48 hr, elevated aPTT, current antocoags, INR > 1.7) -BG < 50
36
45 yo M w. 4 week hx of recurrent nightly 1 hr HA that wake him up during the night - he describes them as a deep excruciating burning sensation centered behind the left eye; he has associated watery eyes/nasal discharge and a sensation of warmth in his face
cluster HA
37
tx for cluster HA
100% O2 at 6-12 L/min for 15 min imitrex
38
glasgow coma score
39
glasgow coma score < _ = coma
9
40
idiopathic pain syndrome that causes continuous pain disproportionate to the any inciting event
complex regional pain syndrome
41
describe the pain w. complex regional pain syndrome
non dermatomal disproportionate to the injury
42
budapest criteria for complex regional pain syndrome
at least 1 sx in 3/4 four categories: -sensory: hyperalgesia and/or allodynia -vasomotor: skin, temp, color, asymmetry -sudomotor/edema: edema, sweating -motor/trophic: decreased ROM or motor dysfxn and/or hair/skin/nail changes
43
tx for complex regional pain syndrome
stage 1: gabapentin, amitryptiline, bisphosphonates stage 2: add steroids stage 3: consult pain management specialist - regional n block/spinal cord stimulators
44
transient, traumatic brain dysfxn
concussion/mTBI
45
6 main sx of concussion
confusion memory loss LOC HA dizzy n/v
46
clinical definition of concussion/mTBI
-glasgow coma score 13-15 30 mins after injury -conscious loss < 30 min post traumatic amnesia < 24 hr -other transient neuro abnl's
47
what tool is used to determine if peds should get imaging post mTBI
PECARN
48
management of mTBI
-2-3 days of physical/cognitive rest -return to school 2-3 days post injury -gradual reintro of activity that does not worsen sx -return to regular activities when able to do all activities w.o experiencing any sx -limit caffeine
49
acute reversible cognitive dysfxn 2/2 to some underlying medical condition
delirium
50
mc type of hallucination associated w. delirium
visual
51
3 rf for delirium
post surgery for heart dz DM etoh abuse
52
main diff btw delirium and dementia
derlirium is usually reversible
53
mc presentation of AMS in the inpatient setting
delirium
54
mcc of delirium
etoh abuse
55
delirium caused by acute hyperthyroidism is called
thyroid storm
56
underlying conditions associated w. delirium (7)
UTI PNA metabolic changes CVA MI TBI meds
57
3 meds known to cause delirium
anticholinergics benzos opioids
58
workup for delirium should include
MMSE/MOCA B12/folate LP if febrile
59
pharm management of acute agitation/psychosis in derlirious pt
haldol
60
long term impaired memory dz that is usually irreversible - represents a marked deterioration from previous level of fxn
neurocognitive d.o
61
2 mc types of neurocognitive d.o
1. alzheimer's 2. vascular dz
62
pathophys of alzheimers
beta amyloid plaques neurofibrillary tangles
63
pharm management of alzheimer's
anticholinesterase drugs: tacrine donepezil
64
rf for vascular disease
arteriosclerotic small vessel dz
65
vascular dz is mc associated w. a
CVA
66
hallmark presentation of vascular dz
-stepwise deterioration w. periods of clinical plateaus -may involve sudden decline
67
mainstay of vascular dz management
bp control
68
neurocognitive d.o characterized by language difficulty, personality changes, and behavioral disturbances
frontotemporal lobar degeneration
69
neurocognitive d.o associated w. parkinsonian sx, hallucinations, gait difficulties, and falls
lewy body dz
70
t/f: neurocognitive d.o are rarely associated w. hallucinations
t! if it is, think lewy body dz
71
neurocognitive d.o associated w. HIV infxn is characterized by
memory deficit impaired executive fxn'ing poor attention/concentration apathy
72
imaging findings of HIV cognitive decline
cerebral atrophy
73
acute inflammation of the brain, often due to bacterial/viral infxn or possibly autoimmune d.o
encephalitis
74
mcc of encephalitis
HSV immunocompromised: CMV
75
5 sx of encephalitis
fever HA AMS sz exanthema
76
how is encephalitis differentiated from meningitis
altered brain fxn'ing w. encephalitis
77
work up for encephalitis
LP MRI PCR
78
shaking that occurs w. simple tastsk like tying shoes, writing, shaving, or holding hands against gravity
essential tremor
79
2 rf for essential atremor
fam hx - autosomal dominant elderly
80
intention/action tremor mc affects the (2)
hands head
81
essential tremor is aggravated by (4)
stress fatigue caffeine temp extremes
82
essential tremor is relieved with
etoh
83
tx for essential tremor
propranolol resistant: deep brain stimulation
84
67 yo F w. severe throbbing HA, visual impairment in left eye - pain is worse w. chewing or combing hair - also feels weak/tired - can't raise arms to reach cabinets - PE shows left sided scalp tenderness, absent left temporal pulse - ESR is elevated
giant cell arteritis/temporal arteritis
85
giant cell arteritis causes inflammation of large blood vessels in the (3)
scalp neck arms
86
4 hallmark sx of giant cell arteritis
HA ttp of scalp jaw claudication w. chewing amaurosis fugax
87
what condition is associated w. giant cell arteritis
polymyalgia rheumatica
88
gs dx for giant cell arteritis
temporal a bx
89
hallmark lab finding of giant cell arteritis
ESR > 100
90
tx for giant cell arteritis
high dose prednisone asap! don't wait for bx results
91
major complication of giant cell arteritis
blindness
92
ascending paralysis beginnign in distal limbs and progressing to total paralysis of all 4 limbs, facial muscles, and loss of reflexes
guillain barre
93
5 rf for guillain barre
post immunization campylobacter jejuni infxn CMV EBV HIV
94
mcc of guillain barre
campylobacter infxn
95
dx for gullain barre
LP: elevated CSF protein WBC wnl
96
tx for guillain barre
plasma exchange IVIG PFTs to monitor resp fxn
97
huntington dz is autosomal _
dominant
98
hallmark presentation of huntington (4)
dementia mutism dysphagia chorea
99
what is chorea
nonrepeating, complex, involuntary rhythmic movements that may appear purposeful
100
genetic testing for huntington shows
40+ CAG repeats
101
MRI findings of huntington
atrophy of cerebrum and caudate nucleus
102
managment of huntington's
chorea: tetrabenzine vs risperidone vs haldol speech therapy
103
types of intracranial tumors
glial meningioma vestibular schwannoma pituitary adenoma neurofibroma CNS lymphoma
104
most _ intracranial tumors are malignant
glial
105
3 types of glial intracranial tumors, mc -> lc
astrocytoma ependymoma medulloblastoma
106
mc type of glial tumor in peds
medulloblastoma
107
4 mc sources of intracranial metastasis
lung breast kidney GI
108
inflammation of membranes surrounding the brain/spinal cord
meningitis
109
meningitis triad
HA fever nuchal rigidity
110
if meningitis is associated w. a petechial rash, think
n. meningitidis
111
mcc of meningitis
enteroviruses
112
bacterial causes of meningitis based on pt pop
neonate: e.coli, GBS (s.agalactiae) most people: s. pneumo immunocompromised: cruptococcus neoformans
113
which type of bacterial meningitis is dx'ed w. india ink stain
cryptococcus neoformans
114
cryptococcal meningitis makes you think
HIV/immunecompromised
115
LP findings of bacterial vs viral meningitis
bacterial: increased pro, decreased glucose viral: no specific, +/- lymphocytes
116
before performing LP for meningitis, you must
CT to check for papilledema
117
tx for meningitis
dexamethasone empirc abx: cephalosporin vs vanco vs pcn viral: IV acyclovir household contacts: rifampin vs cipro vs azithromycin vs ceftriaxone
118
hallmark presentation of migraines
unilateral, pulsating nausea photophobia phonophobia
119
typical duration of migraine
4-72 hr
120
is migraine w. or w.o aura mc
w.o aura
121
tx for migraines: abortive vs prophylactic
abortive: triptans, ergots prophylaxis: atenolol/propranolol, verapamil, TCAs
122
contraindication for triptans and ergots
triptans: ischemic heart dz ergots: pregnant
123
21 yo F w. acute onset of double vision in left eye - 2 months ago she had loss of central vision and pupillary light reflex that resolved spontaneously - PE shows delay in adduction of left eye w. nystagmus of right eye on lateral gaze
MS
124
AI dz that that causes demyelination and scarring of white matter in brain and spinal cord
MS
125
hallmark sx of MS
visual disturbances over many years
126
4 mc sx of MS
sensory loss optic neuritis weakness paresthesias
127
electrical shock sensation in limbs/torso brought on by flexion of the neck
lhermitte's sign -> MS
128
mc type of MS
relapsing-remitting: episodic flare ups over days/weeks btw periods of neuro stability
129
4 types of MS
relapsing-remitting secondary progressive primary progressive progressive relapsing
130
MS that relapses, remits, and then progresses to steady decline
secondary progressive
131
MS with no episodes of remission - steady decline from onset
primary progressive
132
MS that gets worse over time with acute relapses
progressive relapsing
133
gs dx for MS
MRI showing dawson fingers (white matter lesions)
134
what is this showing
dawson fingers -> MS
135
diagnostic criteria for MS
2 episodes/attacks 2 different areas of CNS involved
136
CSF findings of MS
elevated IgG oligoclonal bands
137
pharm tx for MS
acute: steroids prevention: interferon betas (avonex)
138
AI attack of Ach receptors at the neuromuscular junction that results in motor problems
myasthenia gravis
139
hallmark presentation of MG
-fatigability -weakness in every day activities like brushing hair -ptosis and diplopia that improves w. rest
140
MG is associated w. _ hyperplasia and _
thymic thymoma
141
dx for MG: initial/mc vs gs
initial/mc: tensilon test gs: SFEMG (single fiber electromyography) chest CT to r.o thymoma
142
what is the tensilon test
injection w. tensilon results in improved muscle strength
143
moa for tensilon
prevents breakdown of Ach
144
SFEMG findings of MG
decremental response to repetitive stimulation of motor nerves
145
tx for MG
-first line: Achase inhibitor: pyridostigmine/neostigmine -steroids -thymectomy -crisis: plasma exchange/IVIG
146
sx of MG crisis
neuromuscular respiratory failure dysphagia/aspiration
147
parkinson's is caused by degeneration of the _ in the _, which leads to loss of _ containing neurons
degeneration of the basal ganglia in the substantia nigra leading to loss of dopamine containing neurons
148
class of meds that causes parkinsonism
**neuroleptics:** chlorpromazine metoclopramide reserpine
149
parkinsinons' is caused by a _ imbalance
Ach/dopamine
150
triad of parkinsons
resting/pill rolling tremor cogwheel rigidity bradykinesia
151
clinical features of parkinson's (other than triad)
mask facies loss of postural reflexes shuffling gait hypophonia micrographia gait arrest backward falling
152
parkinson's dx is usually clinical, but what is considered gs
neuropathologic exam
153
pharm management of parkinsons
<65 yo: dopamine agonists: bromocriptine, pramipexole, ropinirole >65 yo: sinemet (levodopa/carbidopa)
154
4 common s.e of sinemet
GI upset, n/v vivid dreams/nightmares psychosis dyskinesias
155
typical presentation of peripheral neuropathy
symmetrical stocking and glove distribution
156
pharm managment of peripheral neuropathies
gabapentin amitriptyline topiramate tramadol NSAIDs
157
complication of peripheral neuropathies
charcot's joints
158
2 types of focal sz's
consciousness maintained: simple partial consciousness impaired
159
presentation of consciousness impaired focal sz (aka complex partial sz)
altered consciousness lip smacking postictal state: confusion/memory loss
160
how are consciousness impaired partial sz differentiated from abscence sz
no postictal state w. absence sz
161
tx for focal sz
phenytoin carbamazepine
162
widespread sz activity in the left and right hemispheres of the brain - start midbrain and spread to both cortices
generalized sz
163
6 types of generalized sz
absence tonic-clonic atonic clonic tonic myoclonic
164
brief impairment in consciousness w. abrupt beginning and end - rarely involve involuntary movements - pt has no recollection
absence sz
165
bilat symmetric convulsive sz beginnign w. LOC that involves a post ictal state
tonic-clonic
166
3 phases of tonic-clonic sz
tonic: stiff/rigid x 10-60 sec clonic: generalized convulsions/limb jerking post ictal state: confusion/AMS
167
sz that mimics syncope and involves sudden loss of muscle tone
atonic (drop attack)
168
sz characterized by loss of control of bodily fxn, jerking, and post ictal state
clonic sz
169
sz characterized by extreme rigidity, immediate LOC, and NO involuntary movements
tonic sz
170
sz characterized by muscle jerking, but no loss of muscle tone - mc occurs in the morning
myoclonic sz
171
3 types of sz NOS
febrile infantile spasm psychogenic non-epileptic sz (PNES)
172
3 criteria for febrile sz
temp > 38 > 6 mos old, < 5 yo absence of CNS infxn/inflammation
173
type of epilepsy sz that does not fit into focal or generalized sz
infantile spasm
174
PNES sz may mimic
epilepsy
175
single epileptic sz lasting > 5 min OR >/= 2 or more sz w.in a 5 min period w.o return to normal in between
status epilepticus
176
2 types of status epilepticus
convulsive nonconvulsive
177
convulsive status epilepticus is characterized by
regualr pattern of contraction/extension of the arms/legs
178
nonconvulsive status epilepticus includes (2)
complex partial status epilepticus absence status epilepticus
179
pharm for generalized sz, initial vs maintenance
initial: lorazepam maintenance: phenytoin
180
transient LOC/postural tone 2/2 to acute decrease in cerebral blood flow w. rapid recovery of consciousness w.o resuscitation
syncope
181
5 types of syncope
cardiac vasovagal orthostatic cerebral vascular dz other noncardiogenic
182
3 causes of cardiac syncope
arrhythmias obstruction of blood flow massive MI
183
mc type of syncope
vasovagal
184
3 rf for orthostatic syncope
elderly DM meds
185
5 classes of meds that cause orthostatic syncope
diuretics vasodilating ccb bb nitrates antiarrhythmics
186
hallmark presentation of tension HA
bilat band like distribution mild-mod, dull/squeezing pain
187
tension HA pain is: migraine pain is:
tension: bilat, squeezing/dull migraine: unilateral, pulsating
188
tx for tension HA
NSAIDs muscle relaxants
189
transient episode of neuro dysfxn due to focal brain, retinal, or spinal cord ischemia w.o acute infarction
TIA
190
presentation of TIA
sudden onset <60 min (15-30 min avg) reversal of sx w.in 24 hr
191
4 clinical manifestations of TIA
ICA ICA/MCA/ACA PCA vertebrobasilar
192
typical presentation of ICA TIA
amaurosis fugax - lampshade down on one eye weakness of contralateral hand
193
typical presentation of ICA/MCA/ACA TIA
sudden HA speech changes confusion
194
typical presentation of PCA TIA
somatosensory deficit
195
typical presenatation of vertebrobasilar TIA
brainstem/cerebral sx -> gait/proprioception deficits
196
pharm management of TIA
1. ASA w.in 24 hr 2. clopidogrel 3. high risk: warfarin

EOR - Internal Med (13 decks)

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