Neurology

Question 0

Characteristics of migraine headaches (7)

Answer 0

Pounding, pulsatile pain
Unilateral pain
Worse w/ activity
Assoc with N/V
Phono/photophobia
Disabling intensity
May be assoc with neck/posterior head pain, often described as "sinus pain" (But NO nasal discharge/congest'n)

Question 1

Secondary causes of headache (12)

Answer 1

Vascular (SAH, subdural hematoma, CVA, carotid dissection, ateriovenous malformation, temporal arteritis)
Intercranial masses (primary brain tumour, mets)
Infections (meningitis, sinusitis)
Severe HTN
Pseudotumour cerebri

Question 2

Which primary headache is more common in men than women?

Answer 2

Cluster

Usually presents bet age 30-40

Question 3

Characteristics of cluster headaches (5)

Answer 3

Unilateral
Retro orbital
Sharp/knife-like
Wakes you up at night
Assoc with lacrimation/congestion
Pts often restless or agitated

Question 4

Characteristics of tension headaches (3)

Answer 4

Dull, pressing or tight
Often bilateral
Radiate to neck/occiput

Question 5

Name 7 headache red flags and what Dx they point to

Answer 5

Worst headache of life => SAH
Thunderclap (sudden and severe) => SAH
First exertional headache => SAH, carotid dissection
New headache after 50 => brain tumour, stroke, temporal arteritis
Assoc with stiff neck/fever => meningitis (also SAH)
Behaviour changes => brain tumour
PMHx cancer => mets

Question 6

Medications assoc with headache side effect (5)

Answer 6

Beta blockers
Nitrates
Indomethacin
Phosphodiesterase inhibitors
Estrogen/OCP

Question 7

Important things to check on P/E

Answer 7

Blood pressure
Papilledema
Temporal artery tenderness/pain
Focal neurological findings

Question 8

Best imaging modality for SAH

Answer 8

CT
(Vs. MRI which is better for aneurysms and neoplasms)

LP may show xanthochromia (yellow discolouration of CSF from hemorrhage)

Question 9

Migraine Tx - OTC and Rx

Answer 9

OTC: acetominophen, aspirin
Rx:
Tx: prochlorperazine, metoclopramide (for nausea), triptans (cerebral vasoconstrict)
Prevention: propranolol (beta blocker), amitriptyline, topiramate (anticonvulsant)

Question 10

Tension headache Tx

Answer 10

OTC: acetominophen, aspirin, NSAIDs
Also: Neck stetches, warm compresses, exercise
Rx: baclofen, tizanidine (muscle relaxants)

Question 11

Cluster headache Tx

Answer 11

High flow oxygen
Rx: triptans
Prevention: verapamil

Question 12

Delirium - definition

Answer 12

State of impaired consciousness and cognition
Develops overs hours-days
Clinical fluctuation

Question 13

Conditions increasing susceptibility for delirium (5)

Answer 13

Stroke
Dementia
Parkinson disease
Advanced old age
Sensory impairment (ex. Hearing or vision loss)

Question 14

Important things to look for on P/E in pt with delirium

Answer 14

Vitals => oxygenation
Mucous membrane/skin turgor => hydration
Signs of trauma
Cyanosis, jaundice
Needle tracks
Focal neuro defects
Potential sites of infection
MMSE

Question 15

Tx delirium

Answer 15

DC offending drugs
Tx any infections
Supportive care incl hydration, orienting stimuli, reduce distractions, bedside sitters
Rx: benzos (acute), haloperidol, respiridone, olanzapine (neuroleptics for severe agitation) ***BEWARE: extrapyramidal side FX, QT prolongation

Question 16

Four subtypes of dizziness

Answer 16

Vertigo: peripheral and central
Presyncopal lightheadedness: hypovolemia, vasovagal, Rx
Disequilibrium: Rx, neuromuscular disease, stroke
Other (ex. Psych): hypervent syndrome, hypoglycemia, Rx

Question 17

Causes of peripheral vertigo (6)

Answer 17

Peripheral: abnormalities in the vestibular end organs 
Ex. Benign Paroxysmal Positional Vertigo
Otitis media
Impacted cerumen
Labyrinthitis
Meniere disease
Ototoxic drugs

Usually sudden onset, severe and lasts seconds to minutes, usually assoc with movement and/or tinnitus, hearing loss and full feeling in ear

Question 18

Causes of central vertigo (3)

Answer 18

Cerebellar ischemia (hemorrhage or stroke)
Brainstem ischemia
Vertebrobasilar insufficiency

(Due to abnormalities in CNS vs. vestibular end organs in peripheral)
Usually more gradual onset with milder intensity, can be chronic lasting weeks to months

Question 19

Causes of presyncope

Answer 19

Dehydration
Vasovagal
Rx

Question 20

Objective vs. subjective vertigo

Answer 20

Objective: enviro spinning around them
Subjective: feel they are spinning relative to enviro

Question 21

Describe the Dix-Hallpike test

Answer 21

Provocative stimulation of the vestibular sys => Dx BPPV
Pt seated on table with head rotated at 45 deg, pt moved from seated to supine, neck is extended slightly off the exam table => REPEAT on other side
Make sure eyes are open => test for nystagmus
POSITIVE = vertigo, mixed torsional and vertical nystagmus beating towards forehead

Question 22

Diagnostic criteria for dementia

Answer 22

1. Memory loss
2. One other cognitive dysfunction (ex. Aphasia, apraxia, agnosia, disturbed executive funct’n)
3. Affects social funct’n and is a decline from previous funct’n level. (R/O delirium)

Question 23

Pathologic causes of dementia

Answer 23

ALZHEIMER DISEASE!!! (With neuron loss, extracell beta amyloid plaques, and intracell tau protein neurofibrillary tangles)
Vascular (due to ischemic injury)
Lewy body dementia and Parkinson disease
Fronto-temporal dementia (with pick bodies or ubiquitin)
Normal pressure hydrocephalus (see enlargement of ventricles)

Question 24

MMSE score for Dx of dementia

Answer 24

Less than 24/30

Question 25

Bilateral Hippocampal atrophy on MRI is associated with which kind of dementia?

Answer 25

Alzheimer disease

Question 26

Treatment of dementia

Answer 26

Cholinesterase inhibitors => AD, Lewy Body
NMDA receptor blocker
High dose Vitamin E (in advanced dementia ONLY!)
Trazodone (FTD)
Ventriculoperitoneal shunt (NPH)

Question 27

Reversible causes of dementia (4)

Answer 27

Normal pressure hydrocephalus
Depression
Hypothyroidism
Vit B12 deficiency