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MKSAP - Internal > Neurology > Flashcards

Neurology Flashcards

1
Q

who is at high risk of delirium during hospitalization?

A

elderly pts with dementia

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2
Q

medical indications for catheter

A

relieve urinary retention
monitor fluid status in acutely ill pts
pts with stage 3/4 pressure ulcers on butt
- aside of these indications, remove urinary catheter to prevent things like infection and delirium

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3
Q

which sedatives should be avoided in elderly?

A

benzodiazepines and diphenhydramine

- can precipite delirium

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4
Q

pt post-op presents with acute, fluctuating mental status changes with difficulty focusing or maintaining attention and disorganized thinking

A

think of delirium

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5
Q

patients with chronic dementia are at great risk of what after surgery with general anesthesia?

A

delirium

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6
Q

recommended therapy for delirium in the ICU when supportive care is insufficient?

A

antipsychotic agents - haloperidol

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7
Q

pt presents with mental status changes, nystagmus, opthalmoplegia and unsteady gait - what should you consider?

A

Wernicke encephalopathy - due to thiamine deficiency

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8
Q

conditions assoc with Wernicke encephalopathy

A 
AIDS, alcohol abuse
cancer
hyperemesis gravidarum
prolonged TPN
post-surgical status
glucose loading
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9
Q

cognitive impairment with fluctuating lethargy/inattention, hallucinations and asterixis implies..

A

toxic encephalopathy - ie. medication induced delirium

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10
Q

what types of drugs can provoke delirium in a elderly pts with mild cognitive impairment, early dementia of Parkinson’s disease?

A

anticholinergic drugs (ex. nortriptyline)

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11
Q

migraine with aura consists of..

A

neurologic abnormalities including visual loss, hallucinations, numbness, tingling, weakness or confusion (diffuse symptoms)

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12
Q

aura associated with partial seizures is characterized by..

A

feeling of deja vu, rising epigastric sensation or autonomic disturbances; automatisms (lip smacking) can also be suggestive of partial seizure

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13
Q

pt presents with a headache that is dull, bilateral or diffuse described as a pressure or squeezing sensation; the pain is usually not disabling

A

tension headache

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14
Q

chronic daily headache

A

headache is present on > 15 days/month for at least 3 months

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15
Q

disabling headache assoc with tearing or rhinorrhea; typically unilateral and periorbital/temporal

A

cluster headache

- cluster episodes usually last 6-8 weeks with remission lasting 2-6 months

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16
Q

what is a cluster headache classically assoc with?

A 
lacrimation
rhinorrhea/nasal congestion
eyelid edema
facial/forehead sweating
miosis/ptosis
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17
Q

common visual symptoms associated with migraine

A

perceptions of flashes of light
arcs of flashing light that forms zig-zag pattern
area of loss of vision surrounded by normal visual field

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18
Q

work-up order for “thunderclap headache” as in subarachnoid hemorrhage

A
  1. CT scan without contrast - if neg,
  2. do lumbar puncture, - if neg,
  3. CT or MR angiography
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19
Q

prophylactic tx. of migraine headaches

A

pt should have 2+ headaches per week
first line - propranolol
- can also use: amitriptyline, valproic acid, topiramate, other BB, petasites hybridus

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20
Q

dementia characterized by prominent memory loss, anomia, constructional apraxia, anosognosia (impaired recognition of illness) and personality change

A

Alzheimer’s dementia

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21
Q

dementia the progresses over months and startle myoclonus; also: visual/cerebellar disturbance, pyramidal/extrapyramidal dysfunction and akinetic mutism

A

Creutzfeld Jakob disease

22
Q

dementia accompanied by Parkinsonism, visual hallucinations and fluctuating symptoms; MC includes impaired learning and attention, psychomotor slowing and visuospatial impairment (vs. memory)

A

Dementia with Lewy Bodies

23
Q

pt presents with behavioral and personality changes ranging from apathy to social disinhibition and emotional lability - dementia?

A

frontotemporal dementia

24
Q

stages of dementia based on MMSE

A

MMSE 21-25 = mild dementia
MMSE 11-20 = moderate dementia
MMSE 0-10 = severe dementia

25
Q

first line initial therapy for mild-moderate Alzheimer’s dementia

A

Ach-esterase inhibitors: donepezil, rivastigmine or galantamine

26
Q

first line tx of moderate to advanced Alzheimer dementia

A

memantine

- better effects when added to donepezil

27
Q

what types of drugs are implicated in acute dystonic reactions?

A

neuroleptic, antiemetic and serotonergic agents - dystonic reactions typically occur w/in 5 days of initiating therapy

28
Q

pt presents with resting tremor, bradykinesia, rigidity and postural instability

A

Parkxtinson’s disease

29
Q

upper extremity, high frequency tremor present with both limb movement and sustained posture of the involved extremities and is absent at rest; usually bilateral

A

essential tremor

- usually improved with alcohol and worsens with stress

30
Q

first line therapy of essential tremor

A

propranolol

- others include: primidone, gabapentin, topiramate

31
Q

CSF findings in viral meningitis

A

lymphocytic pleocytosis
glucose > 45
protein < 200
negative gram stain

32
Q

which serogroup of meningococcus does the vaccine not protect against?

A

serogroup B

33
Q

clues to diagnosis of RMSF?

A

headache, fever, myalgia, abdominal pain
rash begins on wrists and ankles
thrombocytopenia, leukopenia and elevated transaminases
infection in spring/early summer

34
Q

CSF and blood cultures with gram positive diplococci

A

strep. pneumo meningitis

35
Q

empiric tx. for bacterial meningitis

A

vancomycin
ampicillin
ceftriaxone
- adjunctive tx. with dexamethasone

36
Q

what is the recommended strategy for reducing complications after acute stroke?

A

early mobilization with physical and occupational therapy

37
Q

tx. of ischemic stroke w/in 3 hours of presentation

A

thrombolysis with tPA

- if not eligible for tPA, give aspirin or clopidogrel

38
Q

threshold for acute BP lowering in pts with acute stroke who are eligible for thrombolysis

A

185/110 mmHg

- use IV labetalol or nicardipine

39
Q

threshold for BP lowering in pts with acute stroke

A

IV labetalol or nicardipine if SBP > 220 mmHg or diastolic < 120 mmHg
(or manifestations of end organ damage)

40
Q

Tx. of subarachnoid hemorrhage

A

surgical clipping of aneurysm with cerebral angiography w/in 72 hours of onset

41
Q

in whom are sumitriptan and other triptan drugs C/I in?

A

pts with stroke and uncontrolled HTN

42
Q

findings in Bell’s palsy

A

complete facial neuropathy impairing the entire hemiface, including foreheard corrugators which are spared by cerebral lesions

43
Q

Bell phenomenon

A

reflexive rolling upwards of the globe during eye closure

44
Q

sensory loss and limb weakness beginning in LE and moving up with absent deep tendon reflexes

A

Guillain-Barre

45
Q

electromyography result in Guillain-Barre

A

demyelinating polyradiculoneuropathy

46
Q

CSF findings in Guillain-Barre

A

albuminocytologic dissociation - spinal fluid cell count is normal but spinal fluid protein level is elevated

47
Q

Tx. of Guillain Barre

A

IVIG and plasma exchange

48
Q

aching wrist pain, numbness and tingling in median nerve sensory distribution of fingers and weakness of thenar muscles; usually worse at night

A

Carpal tunnel syndrome

49
Q

pain elicited by flexing the thumb into the palm, closing fingers over thumb and bending wrist in ulnar direction (Finkelstein test)

A

painful in de Quervain tenosynovitis

- tenderness in anatomic snuffbox

50
Q

synovia filled cysts arising from joints or tendon sheaths that typically appear on dorsal hand or ventral wrist

A

Ganglion cyst

- usually compress other structures and cause pain

51
Q

Guyon tunnel syndrome

A

ulnar nerve compression

52
Q

loss of sensation in a stocking glove distribution that is associated with paresthesias or painful dysesthesias

A

diabetic neuropathy

MKSAP - Internal (11 decks)

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