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Primary care II > Neurology > Flashcards

Neurology Flashcards

1
Q

Cranial nerves

A

On Old Olympuses Towering TOp a Fin and German Viewed Some Hops

  1. Olfactory 2.Optic 3. Oculomotor 4.Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Auditory 9. Glossopharyngeal 10. Vagus 11. Spinal 12. Hypoglossal

Some say marry money but my brother says big brains matter more

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2
Q

Primary headache

A

headache is the disease no secondary cause (HTN, head injury, tumor, menstrual cycle, sleep, TMJ, infection, sinusitis, dehydration)

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3
Q

Migraine characteristics

A 
Recurrent 
4-72 hours 
unilateral 
pulsating 
mod-severe
*aggravated by activity 
n/v
photophobia, phonophobia
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4
Q

Diagnostic criteria for migraine

A

5 or more headaches

2: unilateral, pulsating, mod-severe, agg. by activity
1: n/v, photo/phono

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5
Q

Migraine with or without aura more common

A

without

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6
Q

Migraine with aura criteria

A

One or more aura: visual sensory speech motor brainstem retinal

Two of four: 
One symptom unilateral 
One spreads gradually >5 minutes 
Each symptom lasts 5-40 mins 
Within 60 minutes of migraine
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7
Q

Chronic migraine definition

A

> 15 days per month for 3 months

meeting migraine char. at least 8 days

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8
Q

Tension HA char.

A 
bilateral* 
pressing/tightening 
mild-mod
*not aggravated by activity
*no n/v 
photophobia/phonophobia maybe
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9
Q

Tension HA diagnostic

A

10 episodes occuring on less than 1 day a month (

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10
Q

Cluster HA char.

A 
severe unilateral 
15 minutes - 3 hours 
Ipsilateral conj. injection or lacrimation
Nasal congestion 
Ipsilateral eye edema 
Forehead facial sweating 
Miosis or ptosis 
restlessness agitation**
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11
Q

Temporal arteritis char.

dx
tx

A 
>50 piercing, throbbing, unilateral 
scalp tenderness
low grade fever 
anorexia, malaise 
swollen hands/feet 
Dx: ESR, biopsy gold standard
Tx: high dose oral steroids
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12
Q

HA red flags

A 
worst HA of life 
thunder clap 
change in char. 
abnormal neuro exam 
altered vision 
head trauma 
>50 
altered LOC 
hx cancer 
stiff neck fever
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13
Q

HA comfort signs

A 
\+ fh 
menses 
preceded by typical aura 
periodic and stable 
normal physical and neuro
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14
Q

Primary migraine tx
prophylactic
abortive

A

proph- topamax, propanolol, timolol, CCB
abort- nsaid, excedrin migraine, ergotamine, triptan (1 then 2 hrs after, no more than 2 in 24 hours, no heart disease or pregnancy, SSRI-caution, dec. bp, flushing, throat tightness)

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15
Q

Tension tx
abortive:
other:
prophylactic

A

abortive: NSAIDS, aspirin
muscle relaxant
prophylactic- amitriptylline, nonspecific bb (propanolol, timolol)

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16
Q

Cluster tx
abortive:
other:
prophylaxis:

A

abortive triptan ergotamine intranasal lidocaine
prednisone
prophylactic- ccb

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17
Q 
Parkinsons 
Progressive \_\_\_\_ d.o
Degeneration of \_\_\_\_\_\_ 
Development of \_\_\_\_\_\_\_ 
Decline in \_\_\_\_ and \_\_\_\_\_ fx
A

progresive neurodegenerative
degeneration of dopaminergic neurons
development of lewy bodies
decline in motor and cognitive fx

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18
Q

Cause parkinsons

A

unknown

environmental genetic combination

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19
Q 
Staging of parkinsons 
1. 
2. 
3. 
4. 
5.
A
  1. one side, inconvenient, tremor limb
  2. bilateral, gait affected
  3. slowing, impaired equilibrium
  4. severe, rigidity, bradykinesia, cant live alone, can kind of walk
  5. cannot stand or walk, constant nursing
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20
Q

Ergotamines
cant be used within ___ of triptans
contraindicated in______ may cause _____
dont use with _______

A

can’t be used within 24hrs of triptans,

contraindicated in pregnancy, pvd, heart disease, may case vasospastic events

don’t use with ketoconazole, macrolids (life threatening peripheral ischemia)

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21
Q

Triptans
response
do not use with _____
se:

A

80% response, various forms,

DO NOT use with known CAD, angina, pregnancy

side effects: flushing, throat tightness, serotonin syndrome with SSRIs

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22
Q

Parkinsons presentation

dx

A

rigidity
tremor
bradykinesia
postural instability

dx: 2 symptoms, progression, response with levodopa

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23
Q

PARKINSONS

Bradykinesia def./example

A

slowing of movement
reduced walking speed (reduced arm swing, shuffling gait)
diff. from one motor to another

masked faces, statue like, stooped, drooling, monotonous speech

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24
Q

PARKINSONS

Rigidity def. /example

A

cogwheeling (more pron. on limb with tremor)

noted during passive ROM

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25
``` PARKINSONS Tremor first symptom usually: resting: postural tremor worse with: ```
first symptom: pill rolling resting: asymmetric postural worse with anxiety
26
PARKINSONS | Postural instability
``` poor balance loss of postural reflexes retropulsion test gait freezing FALL RISK*** ```
27
Risk factors migraine
family hx FEMALE birth control food/ETOH 1st HA in early childhood
28
Risk factors tension
stress | TMJ/jaw clench
29
Risk factors cluster HA
MALE caffeine/nicotine age>30 suicide HA
30
Nonmotor symptoms in parkinsons
``` Neuropsychiatric (mood, dep, anxiety, hallucinations) Sleep disturbance (daytime sleepiness, fragmentation) Autonomic (ortho hypo, ED, incont., const., drooling, dysphagia) ```
31
``` Parkinsons fatigue tx: sleep: ED: Constipation: Drooling: Dysphagia: Depression: ```
fatigue: provigil ritalin sleep: meds, dep., motor problems ED: viagra constipation: miralax drooling: botox dysphagia: thickened liq., soft diet depression: TCA
32
Parkinsons Medication
selective MAOI: amantadine dopamine agonist: pramiprexole, ropinorole, bromocriptine carbidopa-levodopa
33
``` Parkinsons Amantadine early: late treatment: renal: SE: ```
early monotherapy late tx: dyskinesia renal adjustment SE: confusion, nausea, blurred vision, hallucinations, NMS
34
Parkinsons Dopamine agonist: early _____ or added to _____ for tx of _____ SE:
dopamine agonists: pramiprexole, ropinorole, bromocriptine early monotherapy or added to levodopa for treatment of motor complications SE: n/v, ortho hypotension, neuropsych: hallucinations, psychosis, impulse control, excessive daytime sleepiness
35
``` Parkinsons carbidopa-levodopa early: late: SE: How to take: ```
early: smooth sustained late: dyskinesia "on off" SE: dyskinesia, dystonia, confusion, psychosis, sedation, n/v, postural hypotension how to take: empty stomach, 30-60 before meal, if nausea nonprotein like fruit
36
most effective parkinsons tx
carb-levo
37
non pharm parkinsons tx
coq10 vitamin c and e | creatinine
38
deep brain stimulation good for: candidates:
good for: poor controlled symptoms desp. tx | candidates: good response to carb-levo, few morbidities, NO cognitive impairment or depression
39
ALS risk factors | death from:
age, family hx | death from: neuromuscular respiratory failure, dysphagia
40
ALS progressive ____ d/o causing ____, _____, and ______. No ______
prog. neurogenerative d/o causing muscle weakness, disability and death. no remission 3-5 years dx to death
41
dx als
upper and lower motor neuron signs progression no alt. explanation no test to rule in or out
42
ALS history
progressive symptoms over segment spreads to other segments months to years involuntary weight loss and muscle wasting
43
S/S ALS
upper lower motor signs upper: weak, slow, hyperreflexia, spasticity lower: weak, atrophy, amyotrophy, fasciculation other: strained voice, weakness of tongue, lips, swallowing problems, inappropriate crying, laughing, yawning, paresthesia, cognitive impariment, delayed eye closure
44
most common presentation ALS
asymmetric limb weakness (hand, foot dorsiflexion)
45
pseudobulbar ALS
inappropriate crying, laughing, yawning
46
tx ALS
interdisciplinary | rilutek- slows progression tracheostomy feeding tube
47
MS dx
H&P Mcdonald criteria MRI CSF
48
MS mcdonald criteria
review on slide
49
MS vision
most common eye problem optic neuritis acute, unilateral eye pain worse with movement diplopia decreased acuity tx: steroids
50
MS sensory
paresthesia coldness radicular pain intense itching cervical dermatomes
51
MS neuro
ataxia/gait tremor speech cognitive impairment
52
MS PE Eyes: Sensory:
Eyes: decreased pupillary reaction (marcus gunn); fundoscopic normal or edema, nystagmus Sensory: impaired vib., position sense, light/touch perceptions, pinprick increase
53
MS symptoms
``` gait weakness vision changes neuro (numbness, tingling) bowel bladder dysfunction heat sensitivity (uhthoff) fatigue depression ```
54
MS tx | Acute:
steroids | otherwise supportive pain incont. fatigue
55
Stroke def.
interruption of blood circulating to brain---> neurologic deficit
56
87% of strokes are
ischemic
57
TIA def. | risk of stroke?
neuro deficit resolves in a few hours-24 hours | 9x more likely
58
Types of stroke
Ischemic: blockage of blood vessels lack of blood to area Hemorrhagic: rupture of blood vessels, leakage of blood to area
59
Risk factors ischemic
Both: HTN, family hx, smoking, drug use | male, race, previous stroke, carotid stenosis, afib, chf, mitral stenosis, prosthetic valve, MI
60
Risk factors hemorrhagic
Both: HTN, family hx, smoking, drug use polycystic kidney dx, ehlers-danlos, lupus, neurofibromatosis, tuberous sclerosis, pregnancy, atherosclerosis, alcohol intoxication
61
Ischemic stroke causes
Atherosclerotic: dislodges Afib: clot Lacunar infarct: elderly, diabetic, smaller areas of brain- arterioles
62
Hemorrhagic stroke are more typically occurs in causes
deadly occurs in adults age 40-60 causes: subarachnoid, AV malformation, trauma
63
``` Presentation of stroke diff. b/w TIA and stroke neuro: ischemic and ha: subarachnoid: ```
``` diff b/w TIA and stroke: time frame neuro: varies dep. on area ischemic and HA: usually not single attack evolves hours to days subarachnoid: severe HA, n/v ```
64
Dx stroke Ischemic Hemorrhagic
non-contrast head CT ischemic: may be normal up to 24 hours hemorrhagic: may need arteriogram
65
Tx strokes
TPA; ischemic within 3 hours, not if bleeding risk surgery antiplatelet: ASA (TIA ischemic prevention) coumadin (afib, artificial valves, LVD with CHF), plavix, xarelto/pradaxa/eliquis acute: hospitalize
66
Risk factor modification for strokes
simple 7: active, control cholesterol, eat better, manage bp, lose weight, reduce sugar, stop smoking
67
Seizures | Generalized types
``` absence (petit mal) atypical absense myoclonic (jerk) tonic clonic (stiff) tonic, clonic, or stonic ```
68
seizures highest incidence | risk factors
children | risk: family hx, previous seizure, brain tumor, hx neuro insult, withdrawal anticonvulsants

Primary care II (13 decks)

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