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Pance Re-Up > Neurology #3 Precision and Pearls > Flashcards

Neurology #3 Precision and Pearls Flashcards

1
Q

There are two types of focal (partial) seizure. Explain the difference between the two types
-Simple
-Complex

A

-Simple: consciousness maintained
-Complex: consciousness impaired

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2
Q

What diagnostic should be done for focal/partial seizures?

A

EEG

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3
Q

On an EEG, what is seen in a simple focal seizure?

A

Focal discharge at onset of seizure

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4
Q

On the other hand, what is seen with a complex focal seizure on an EEG?

A

-Interictal spikes at temporal or frontotemporal area

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5
Q

An absence (petit mal) seizure involves _________ and is MC seen in childhood. Explain the symptoms of this type.

A

Both hemispheres

-Pause/stare without loss of body tone
-Episodes last 5-10 seconds, eyelid twitching, lip smacking
-No postictal phase

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6
Q

What is seen on EEG in an absence seizure?

A

Bilateral symmetric 3 Hertz spike and wave activity

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7
Q

What is the first-line treatment for an absence seizure?

A

Ethosuximide

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8
Q

What two medications can exacerbate absence seizures?

A

Carbamazepine and Gabapentin

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9
Q

With generalized (grand mal) seizures, which are simultaneous neuronal discharge of both hemispheres, what are some symptoms?

A

Tonic Clonic (Grand Mal): sudden loss of consciousness with tonic activity (contraction and rigidity) followed by 1-2 minutes of clonic activity (repetitive movements) followed by postictal confusion phase.
-Cyanosis and urinary incontinence can occur

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10
Q

What two labs are elevated following seizures?

What is seen on EEG in a patient with a grand mal seizure?

A

Prolactin and lactic acid

High amplitude rapid spiking

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11
Q

What are some long-term treatment options for epilepsy?

A

Levetiracem, Phenytoin, Valproic Acid

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12
Q

What is status epilepticus?

A

Single, continuous seizure lasting 5 minutes or more, or more than 1 seizure in 5 minutes without recovery between

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13
Q

What is the first line treatment for status epilepticus

A

Benzodiazepines (Lorazepam)

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14
Q

Phenytoin has a MOA of _________ and some side effects include…..

A

Blocks voltage gated sodium channels

-P450 Inducer (Lupus Like Sx)
-Hyperplasia of gums and Hirsuitism
-Erythema Multiforme
-Osteopenia
-Nystagmus

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15
Q

On the other hand, Carbamazepine __________ and is the drug of choice for _________. Some other side effects of this medication are

A

-Blocks Na+ channels
-DOC in trigeminal neuralgia

-Hyponatremia (causes SIADH)
-SJS, Hepatotoxicity
-P450 Inducer (Lupus)

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16
Q

Ethosuximide is only used for what type of seizures?

What does this drug do?

A

Absence seizures

Blocks calcium channels, decreases neuronal firing

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17
Q

Another treatment option for seizures, topiramate, blocks Na+ channels and increases GABA, and is a glutamate receptor antagonist, has a side effect of…

A

Renal stones

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18
Q

Tourette Disorder, onset in childhood and MC in boys, has two diagnostic criteria. Name them.

A

Onset before age 18

Multiple motor and 1 or more vocal tic for > 1 year

19
Q

What are some symptoms of Tourette Disorder?

A

-Motor tics: blinking, sniffling, etc.
-Verbal tics: obscene words, throat clearing, echolalia (repeat others)
-Self Mutilating tics: hair pulling, nail biting

20
Q

What is the treatment for Tourette Disorder?

A

-Habit reversal therapy (1st line)
-Dopamine blockers (Tetrabenazine)
-Clonidine, Guanfacine are other options

21
Q

MC etiology of TBI

A

Falls

22
Q

What scoring system is used to quantify a TBI? What is the worst and what is the best? What are the components?

A

-Glascow Coma Scale
3 is worst, 15 is best
-Eye Response, Verbal, Motor

23
Q

Treatment for a TBI

A

-ICU admission
-Endotracheal intubation
-Decrease ICP: elevate head of bead, Mannitol

24
Q

What exactly is a concussion? What are some symptoms?

A

Mild TBI leading to AMS with or without LOC

-Headache, confusion, amnesia, blurry vision, emotional instability, vomiting, etc.

25
Q

What diagnostics should be done for a concussion? When should an MRI be done

A

CT head without contract (DOC)

-MRI if symptoms > 7-14 days or worsening symptoms

26
Q

Treatment for a concussion

A

-Cognitive and physical rest
-Observe for 24 hours
-Resume activity after all symptoms resolve

27
Q

Post concussive syndrome is 3 symptoms for > 3 months after concussion. What is the MC symptom?

A

Headache

28
Q

What are the symptoms of a lower motor neuron injury. Think FLABBY

A

-Fasiculations, Flaccid Paralysis
-Loss of muscle tone/strength
-Areflexia
-Babinski Downward
-Young

29
Q

What are conditions that cause lower motor neuron injury (think B’s)

A

-Botulism
-Guillan Barre
-Bell Palsy
-Cauda Equina Syndrome

30
Q

What are symptoms of an upper motor neuron injury. Think, muscles are SPASTIC

A

-Slight muscle loss
-Positive Babinski (toe up)
-Absence of Fasiculations
-Strong Tone
-Increased DTR’s
-Clonus

31
Q

What conditions cause upper motor neuron injuries? Think of the S’s

A

-Stroke
-Multiple Sclerosis
-Spinal Cord or Brain Damage (TBI)
-Cerebral Palsy

32
Q

What are symptoms of cerebral palsy

A

-Spasticity (hallmark)
-Motor deficits
-Intellectual or learning deficits
-Non progressive
-Limb length discrepancies
-Gross motor delay
-Asymmetric crawling
-Most onset before 3 years old

33
Q

What diagnostic is done for cerebral palsy?

A

MRI

34
Q

Treatment for cerebral palsy

A

-Pain management
-Baclofen or Diazepam for spasticity

35
Q

Trigeminal neuralgia is……..

It is MC in who?

A

Compression of cranial nerve V

MC in middle-aged women

36
Q

If trigeminal neuralgia occurs in someone YOUNG, think….

A

Multiple Sclerosis

37
Q

Symptoms of Trigeminal neuralgia

A

-Brief episodic sharp pain on face
-Worse with touch, chewing, wind gusts
-Starts near mouth –> eye –> nose –> ear

38
Q

Treatment for Trigeminal Neuralgia

A

-Carbamazepine (FIRST LINE)
-Oxcarbazepine

39
Q

What is Amyotrophic Lateral Sclerosis (ALS)

A

Necrosis of both upper and lower motor neurons, leading to progression motor degeneration

40
Q

Symptoms of ALS

A

-Asymmetric limb weakness (MC initial)
-Bulbar symptoms (chewing, aspiration)
-Mixed upper and lower motor neuron signs
-Sensation, eye movement, sphincter function, and sexual function spared

41
Q

How do you diagnose ALS?

What lab is elevated

A

EMG

Elevated Creatine Phosphokinase

42
Q

Treatment for ALS

A

-Riluzole: reduces glutamate buildup in neurons
-Fatal within 3-5 years because respiratory failure MCC of death

43
Q

What is the MCC of death in those with ALS?

A

Respiratory failure in 3-5 years

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