Neurology Flashcards
1
Q
How does a brain tumor HA present?
A
- Dull and persistent HA always in the same spot
- Personality changes, vision changes
2
Q
How likely for TIA to develop into CVA?
What can we do?
A
- 1/3 chance
- Start aspirin and stop smoking/exercise
3
Q
Wernicke’s area deficit
Who might get this?
A
- Receptive aphasia - impaired speech comprehension
- Alcoholics with B1 (thiamine) deficiency
4
Q
Broca’s area deficit
A
- Expressive aphasia
5
Q
Characteristics of cluster HA (3)
A
- Sudden, sharp, unilateral HA behind the eye
- Sweaty
- Runny nose and tears
6
Q
When do cluster HAs occur?
A
- Same time every day
- May have multiple attacks in a week
7
Q
Treatment of cluster HA (3)
A
- 100% O2 for at least 20min
- Imitrex SQ
- Intranasal lidocaine
8
Q
Cluster HA prophylaxis
A
- Verapamil
- CCB that won’t cause a HA
9
Q
Cluster HA patients have a high risk of what?
A
- Suicide
10
Q
How does Giant Cell Temporal Arteritis present? (3)
What kind of HA?
A
- Unilateral HA
- Cord-like temporal artery – painful, warm, pulsing
- Jaw claudication (pain with chewing)
- Possible vision loss
11
Q
Lab elevated in Giant Cell Temporal Arteritis?
What is this condition associated with?
A
- ESR/CRP
- Polymyalgia Rheumatica
12
Q
How to diagnose Giant Cell Temporal Arteritis?
A
- Biopsy of temporal artery
13
Q
What to do if patient with Giant Cell complains of blurry vision?
A
- Send to ER to prevent permanent vision loss
- Treat right away before diagnostics are back
14
Q
How do we treat Giant Cell Temporal Arteritis?
A
- Prednisone 1-2 years
15
Q
How does HTN HA present?
A
- Occipital HA usually in the morning
16
Q
Which HA present bilaterally?
A
- Tension HA
17
Q
Medications used for migraine prophylaxis (4)
A
- Propranolol
- TCAs – amitriptyline
- Topamax
- Depakote
18
Q
How many migraines to qualify for prophylaxis?
A
- 4+ HA per month
19
Q
Contraindications to triptans? (2)
A
- Uncontrolled HTN/CAD
- Serotonin meds
20
Q
Do all triptans work the same?
How to take?
A
- No – if one doesn’t work, another one might
- Take as soon as they feel the HA coming on
21
Q
Common presentation of a migraine HA?
A
- Unilateral throbbing HA
- photophobia
- phonophonia
- N/V
22
Q
Migraine without aura Diagnostic criteria
A
- At least 5 HA lasting 4-72hr
- 2 of the following: unilateral, pulsing, mod/severe intensity, aggravation by regular activity
- 1 of the following: N/V, photophobia/phonophobia
23
Q
Migraine with aura diagnostic criteria
A
- At least 2 HA lasting 4-72 hours
- Clear description of aura
24
Q
What happens in Parkinson’s?
A
- Depletion of Dopamine
25
How does Levodopa work?
- Converts to Dopamine in the brain
- Carbidopa prevents our body from destroying the dopamine
26
When to start Sinemet?
What does it help with the most?
- When symptoms interfere with quality of life
- Bradykinesia
27
Side effects of Sinemet?
- Hypotension, dizziness, GI upset
28
How long does Sinemet usually work?
- 3-5 years
- Wearing-off phenomenon – symptoms can worsen even before the next dose is due
29
What does Requip help with? (3)
- RLS
- Resting tremor
- Delay starting of Sinemet
30
Side effects of Requip
- Impulse control
- Leg edema
- Hypotension
31
Medications used for Essential Tremor (2)
What else can help? (2)
- BB
- Botox
- Physical activity and alcohol
32
What can worsen an essential tremor? (2)
- Caffeine
- Sex
33
What are the 3 A’s of Alzheimer’s?
- Agnosia
- Apraxia
- Aphasia
34
What test can we use to diagnose cognitive changes?
MMSE
35
Medication used for Alzheimer’s (2)
- Aricept (cholinesterase inhibitor)
- Namenda (NMDA antagonist)
36
Cranial Nerve I
Function
- Olfactory
- Smell
37
Cranial Nerve II
Function
- Optic
- Visual acuity/SNELLEN
38
Cranial Nerve III
Function
- Oculomotor
- Eye movement, focus, blink
39
Cranial Nerve IV
Function
- Trochlear
- Eye movements: down and towards nose
40
Cranial Nerve V
Function (2)
- Trigeminal
- Chewing, face sensation
41
Cranial Nerve VI
Function
- Abducens
- Eye movements - outward
42
Cranial Nerve VII
Function
- Facial
- Facial expression, raise eyebrows, puff cheeks
43
Cranial Nerve VIII
Function
- Vestibular
- Hearing and balance
44
Cranial Nerve IX
Function
- Glossopharyngeal
- Taste
45
Cranial Nerve X
Function
- Vagus
- Swallowing, gut function
46
Cranial Nerve XI
Function
- Accessory
- Move shoulders/neck
47
Cranial Nerve XII
Function
- Hypoglossal
- Move tongue
48
Which cranial nerve can be affected by an unresolved cholesteatoma?
- CN VII
49
Treatment for trigeminal neuralgia?
Second line?
- Tegretol
- Second line: TCA
50
Tegretol side effects
- Bone marrow suppression
51
Which CN is affected by Bell’s Palsy?
- CN 7
52
Bell’s Palsy
Diagnosis
Treatment
- Dx based on clinical presentation
- Start steroids within 72 hr
53
What can precipitate Bell’s palsy? (3)
- Pregnancy, HTN, DM, HSV
54
What is sarcoidosis?
How can it present?
- Formation of tiny inflammatory cells (granulomas)
- Bilateral facial paralysis
55
What is otosclerosis?
Biggest concern?
- Disease of the inner ear
- Permanent hearing loss d/t breakdown of the cochlea
56
Symptoms of otosclerosis?
What kind of hearing loss?
- Vertigo, tinnitus, nystagmus
- Conductive hearing loss
57
What is happening in MS
Common age?
- Demyelination in the CNS
- 20-40
58
MS most common in who?
- Northern European descent
59
Symptoms of MS (4)
What usually presents first?
- Weakness
- Balance problems
- Incontinence
- Vision issues – often first complaint
60
Complication of MS
- Optic Neuritis
61
Symptoms of optic neuritis
- Vision loss in 1 eye
- Blurred vision
- Reduced color vision
62
Treatment of optic neuritis
- Steroids
63
How is MS diagnosed?
Treatment?
- MRI
- Steroids and DMARDs
64
People with MS at a higher risk of developing what?
- Trigeminal Neuralgia and Optic Neuritis
65
Treatment options for absence SZ (4)
- Zarotin
- Depakote
- Dilantin
- Lamictal
66
What it an atonic seizure?
- Drop attacks
- Sudden loss of muscle strength
67
When can we DC seizure meds?
- No seizures for 2-4 years
68
Side effects of Depakote
- Weight gain and hair loss
69
Who shouldn’t have Depakote or Dilantin?
- Patients with liver problems
70
Side effects of Dilantin
- Gingival hyperplasia
- Hirsutism
- Decreased level of BC
71
Treatment for postherpetic neuralgia
- Gabapentin
72
What is meclizine good for?
- BPPV and Labyrinthitis
73
What is ALS
- Most common degenerative disease of motor neurons
74
What is a sign of spinal stenosis
- Neurogenic claudication relieved by sitting or lying down
75
What is Topamax used for?
- Migraine prophylaxis
- Seizures
- Weight loss
76
Who should not have Topamax?
- Renal and liver problems
- Kidney stones
- Hx anorexia
77
How often can we use triptans?
- 2 days a week d/t risk of rebound HA
78
Symptoms of meningitis
- Flu like symptoms
- Progression: confusion, can’t walk, rash, severe unrelenting HA, stiff neck, photosensitivity
79
How to diagnose meningitis
- LP: WBCs
80
What might kids need before returning to sports after a concussion?
- Impact testing
81
What is another medication that can be used in migraine attacks?
- Rimegepant (Nurtec)
82
Best treatment for tension HA?
- NSAIDs and stress reduction
83
What is the pathology of Alzheimer’s?
- Deposits of beta-amyloid plaques and neurofibrillary tau protein tangles
84
Pathology of vascular dementia
- Ischemic changes secondary to CVA
85
What is the confrontation test?
- Evaluation of visual fields using counted fingers with central focus
86
How to perform Romberg Test
- Stand with feet together and eyes closed and open for 30 seconds
87
Meniere’s disease symptoms (3)
- Episodic vertigo
- Hearing loss
- Tinnitus
88
Diagnostic criteria for Meniere’s disease
- 2 or more episodes of spontaneous vertigo lasting 20min to 3 hours
- Hearing loss that is confirmed by audiometry
- Fluctuating tinnitus
89
What is Wernicke Aphasia characterized by?
- Impaired speech comprehension
90
First line treatment for neuropathic pain
TCAs
91
What is agnosia
- Impairment in the ability to understand information in relation to the 5 senses
92
What medications aside from steroids are used in severe Bell’s Palsy?
- Acyclovir
93
Chovsteks looks for what?
- LOW calcium
94
Which CN can cause blindness when affected by Herpes Zoster?
- CN V
