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PANCE > Neurology > Flashcards

Neurology Flashcards

1
Q

what are reversible causes of dementia?

A 
hypothyroisidm
depression
pernicious anemia
bismuth poisoning
normal pressure hydrocephalus
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2
Q

is dementia more or less likely in parkinsons

A

more likely

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3
Q

what headache is bilateral, non-throbbing, band-like

A

tension headache

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4
Q

treatment for tension headache?

A
  1. NSAID (ibuprofen, ketoralac if severe)
  2. caffeine containing agents
  3. avoid opiates
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5
Q

prevention for tension headaches?

A

TCA (amitriptyline)

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6
Q

prevention for tension headaches?

A

TCA (amitriptyline)

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7
Q

What headache is unilateral, throbbing, pulsatile, has n/v, photophobia, photophobia, often preceded by aura?

A

migraine headache

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8
Q

treatment for migraine headache?

A

triptan (sumatriptan)

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9
Q

prophylaxis for migrane headaches?

A

propranolol

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10
Q

prophylaxis for basilar migraine (bickerstaff syndrome)?

A

verapamil

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11
Q

what headache is severe, unilateral, orbital/supraorbital, ipsilateral symptoms = lacrimation, eye injection, rhinorrhea, increased sweating and cutaneous blood flow, affects me?

A

cluster headache

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12
Q

cluster headache treatment and prophylaxis ?

A

triptan + 02

prophylaxis = verapamil

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13
Q

Describe Horner syndrom?

A

unilateral ptosis
miosis
anhydrosis

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14
Q

Describe Horner syndrome?

A

unilateral ptosis
miosis
anhydrosis

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15
Q

Describe Horner syndrome?

A

unilateral ptosis
miosis
anhydrosis

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16
Q

What is non-dermatomal limb pain following soft tissue injury of fracture?

A

complex regional pain syndrome (reflex sympathetic dystrophy)

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17
Q

What are the symptoms of complex regional pain syndrome?

A

local = limb pain, swelling, reduced ROM, skin changes

autonomic = cyanosis, mottling, increased sweating, cold

Urologic = incontinence or urinary retention

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18
Q

Treatment for stages 1/2/3 for complex regional pain syndrome?

A

Stage 1: neuron tin, alluvial and alendronate (bisphosphonate)

Stage 2: add steroid

stage 3: include pain management specialist

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19
Q

most common type of peripheral neuropathy?

A

diabetic neuropathy

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20
Q

What are the 3 types of peripheral neuropathy?

A
  1. Axonal -sensory
    Slow onset: DM, uremia “stocking glove pattern.” Rapid onset = drugs
  2. myelinating - motor; ascending = guillain barre
  3. hereditary - charcot-marie-tooth: peroneal nerve disease
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21
Q

Diagnosis for peripheral neuropathy/

A

electromyography/nerve conduction study

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22
Q

Treatment for pain with peripheral neuropathy?

A

gabapentin, pregabalin, amitriptyline

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23
Q

spontaneous leg movement while at rest, unpleasant paresthesias,?

A

restless leg syndrome

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24
Q

What is restless leg syndrome associated with (4)?

A
  • peripheral neuropathy (DM)
  • uremia (endstage renal disease)
  • pregnancy
  • iron deficiency
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25
Q

Treatment for restless leg syndrome?

A
  • dopamine agonists (pramipexole, ropinirole)

- iron therapy

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26
Q

symptoms of Bell’s Palsy (6)?

A
  • unilateral facial paralysis
  • inability to wrinkle forehead
  • inability to close eye, decreased tearing
  • loss ot taste sensation
  • pain around ear precede facial weakness
  • mouth drawn to the unaffected side
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27
Q

Cause of Bell’s Palsy?

A

herpes simplex virus

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28
Q

Herpes zoster + Bell’s Palsy = _____?

A

Ramsay Hunt syndrome

herpes zoster of face complicated by same side facial palsy and vertigo

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29
Q

Treatment of Bell’s Palsy?

A
  • oral steroids (prednisone) = begin soon (mainstay)

- supportive care = lubricating eye drops, protective glasses or goggles, patches

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30
Q

Describe a TIA?

A
  • brief episode of neurologic dysfunction due to focal, temporary cerebral ischemia without cerebral infarction
  • no longer than 24 hours
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31
Q

What are the 2 types of TIA?

A
  • large artery (low flow) = short/minutes = stenosis

- embolic (longer- hours)

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32
Q

When do you treat carotid stenosis with surgery?

A

when stenosis >70%

33
Q

Workup for TIA?

A
  • CT w/o contrast
  • US of carotids
  • echo with doppler
  • ekg/labs
34
Q

Treatment for TIA?

A
  • admit
  • aggrenox or aspirin
  • if CAD + TIA = plavix
  • if TIA due to fib = warfarin
35
Q

What is CHADS2 score?

A

indication for warfarin therapy if >2

  • CHF
  • HTN
  • Age >75
  • DM
  • S2 prior stroke
36
Q

What symptoms do you expect with a TIA in the carotid circulation?

A
  • contralateral hand-arm weakness with sensory loss
  • ipsilateral visual symptoms or aphasia
  • amaruosis fugax
  • carotid bruit may be present
37
Q

What symptoms do you expect with a vertebrovascular TIA?

A

-diplopia, ataxia, vertigo, dysarthria, CN palsy, LE weakness, dimness or blurring of vision, premolar numbness, drop attacks

38
Q

Ischemic stroke 2 types?

A
  • thrombotic

- embolic

39
Q

What arteries are affected in the anterior circulation stroke/TIA?

A
  • carotids to frontal

- middle cerebral arteries

40
Q

homonymous hemianopia?

A

ischemic stroke - anterior circulation

41
Q

signs of anterior circulation stroke?

A

aphasia, apraxia, hemiparesis, hemisensory loss, visual field defects

(middle cerebral arteries)

42
Q

Exclusion criteria for tPA for ischemic CVA?

labs and CT result

A

CT without contrast = intracranial hemorrhage, multi lobar infarct involving >33% of cerebral hemisphere

labs: platelet 1.7; elevated PTT

43
Q

Exclusion criteria for tPA for CVA based on history (10)?

A
  • CVA or head trauma in last 3 months
  • hx of intracranial hemorrhage
  • major surgery in last 14 days
  • GI or urinary bleeding in last 21 days
  • MI in last 3 months
  • arterial puncture of a non-compressible site for last 7 days
  • use of dabigatran in last 48 hours
  • stroke symptoms
  • BP >185/110
  • active bleeding or acute trauma/fracture
44
Q

S/S for posterior circulation TIA?

A

VANISH’D

  • vertigo
  • ataxia
  • nystagmus
  • intention tremor
  • slurred speech
  • heel-shin test
  • dysdiadochokinesia
  • broad based gait
45
Q

What arteries are affected in posterior circulation TIA?

A

vertebral and basilar

46
Q

What is the most significant and treatable risk factor for stroke?

A

HTN

47
Q

What is the best test to differentiate ischemic from hemorrhagic stroke?

A

CT w/o contrast

48
Q

What are the 4 types of cerebral aneurysms?

A
  1. saccular - thin walled
  2. fusiform - dilation of entire circumference of vessel
  3. berry/saccular - circle of willis
  4. mycotic - infected emboli
49
Q

when do aneurysms become symptomatic?

A

when they rupture (bleeding into subarachnoid space)

50
Q

risk factors for cerebral aneurysm?

A
  • HTN, smoking, hypercholesterolemia, heavy etoh
  • polycystic kidney disease
  • coarctation of the aorta
51
Q

first study to get if suspect cerebral aneurysm or SAH? and 2nd study?

A

CT/MRI

-lumbar puncture (bloody)

52
Q

Treatment of cerebral aneurysm?

A
  • supportive (prevent elevated intracranial pressure) = bed rest, stool softener
  • manage HTN
  • surgery = clipping or coiling
53
Q

worst headache of my life? and other symptoms?

A

subarachnoid hemorrhage

  • sudden onset, severe
  • n/v, seizure, altered LOC
  • agitated pacing
54
Q

workup for subarachnoid hemorrhage?

A

CT

then lumbar puncture (bloody)

55
Q

What are hemorrhagic strokes usually due to?

A

HTN

56
Q

What is the most common source of intracranial metastasis?

A

carcinoma of the breast (#1), lung, GI, kidney

57
Q

symptoms for brain tumor in frontal lobe?

A

personality or intellectual change

58
Q

symptoms for brain tumor in temporal lobe?

A

olfactory or gustoatory hallucination, licking or smacking of lips

59
Q

symptoms for brain tumor in parietal lobe?

A

sensory seizure or sensory loss (impaired stereognosis)

60
Q

symptoms for brain tumor in occipital lobe?

A

visual defect or visual hallucination

61
Q

symptoms for tumor on brain stem?

A

CN palsy, ataxia (nystagumus)

62
Q

symptoms for tumor on pituitary?

A

visual loss, endocrine symptoms

63
Q

What is the most common type of primary intracranial neoplasm?

A

-gliomas

the rest are meningiomas, pituitary adenoma, neurofibromas, etc

64
Q

Patient presents with initial transient loss of consciousness from injury, then lucid period, then increased drowsiness/HA, then weakness….what do you suspect? what artery might be affected? treatment?

A

suspect epidural hematoma

  • artery = middle meningeal artery
  • CT = biconvex lens-shaped appearance
  • treatment = small (observe); large = surgery
65
Q

lens shaped appearance on CT?

A

epidural hematoma

66
Q

major head trauma,, CT shows crescent-shaped lesion

A

subdural hematoma

Treatment =

  • small = observe
  • large = burr holes, craniotomy, antiepilepitc drug for seizure prevention, watch for intracranial pressure
67
Q

What can spontaneous subdural hemorrhages occur with?

A

blood thinners, etoh, cerebral atrophy

68
Q

Most common source of brain injury in the young? the elderly?

A 
young = MVA
elderly = falls
69
Q

What are the 3 types of subdural hemorrhage?

A 
acute = hours-2day
subacute = 3-14 day
chronic = 15+ days
70
Q

What is the difference between generalized or partial seizures?

A
  • Generalized = affects entire brain {convulsive vs non convulsive}
  • partial = affects one side (often temporal lobe) {simple vs complex}
71
Q

describe generalized absence seizures?

A

start around age 3 - conscious but unaware

  • staring
  • last
72
Q

Describe simple partial seizures?

A
  • consciousness is not impaired
  • symptoms aura-like, smells, sights
  • focal rhythmic discharge
73
Q

Describe complex partial seizure?

A
  • consciousness is impaired
  • last >30 seconds
  • may have unilateral limb twitching
  • temporal lobe
  • interictal spikes
74
Q

Children born with _____ have increased incidence with seizures?

A

sturge-weber syndrome (port wine stain)

75
Q

What is a Jacksonian seizure?

A

type of simple partial seizure

  • originates in the motor cortex
  • small jerking movements occur at the hand and then spread to other motor areas
76
Q

Describe tonic-clonic seizures (grand mal)

A

body very stiff and rigid, 10-60 sec, often bite tongue, incontinence of urine or feces
-EEG = spike

77
Q

What is status epileptics? and treatment?

A

single nonstop seizure longer than 5-10 minutes, no return to baseline

medical emergency

IV lorazepam
2nd line = phenytoin

78
Q

what is neurogenic syncope?

A

vasovagal syncope

  • transient LOC due to reflex response of vasodilatation and/or bradycardia causing hypotension and cerebral hypo perfusion
  • triggered by stress (venipuncture, painful stimuli, fear, prolonged standing, heat)
79
Q

Glasgow Coma Scale scores

A 
3 = min points
15 = max points

13 = minor brain injury

PANCE (16 decks)

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