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Family Medicine EOR > Neurology 6% > Flashcards

Neurology 6% Flashcards

1
Q

What is the most common risk factor for developing Alzheimer disease?

A

old age

The most common form of dementia

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2
Q

Patients with ———– often see an early onset of Alzheimer by the age of 40 due to the presence of APP gene on chromosome 21

A

Down’s syndrome

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3
Q

Dx of alzheimer’s Dz

A

Definitive diagnosis is by brain biopsy (after autopsy)

Alzheimer’s disease is essentially a clinical diagnosis; exclude other causes first. Formal neuropsychological testing to confirm the diagnosis

An intellectual decline in 2+ areas of cognition
Documented by MMSE or similar scale
CT scan or MRI showing diffuse cortical atrophy with enlargement of the ventricles strengthens the diagnosis
CBC, CMP, heavy metal, calcium, glucose, TSH, B12, renal, LFT, drug/ETOH levels

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4
Q

Tx for alzheimer’s disease x2

A

Cholinesterase inhibitors (first line): donepezil, rivastigmine, galantamine - brains of patients with Alzheimer disease have lower levels of acetylcholine

Memantine (NMDA-receptor antagonist): mod-severe
Certain dietary supplements (ginkgo, lecithin) have not been proven to be beneficial.

Avoid anticholinergics

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5
Q

Hemifacial weakness/paralysis of muscles innervated by CN VII due to swelling of the cranial nerve

A

Upper respiratory infection is a common preceding event

bells palsy

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6
Q

There is an acute onset of unilateral facial weakness/paralysis. Both the upper and lower parts of the face are affected (differentiate quickly from stroke - can wrinkle forehead)

A

bell’s palsy

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7
Q

Bell’s palsy diagnosis
What to consider in endemic areas?

Consider ——–testing if paresis fails to resolve within 10 days

A

consider Lyme disease in endemic areas
(Do NOT use steroids if Lyme is suspected!)

EMG testing

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8
Q

Bell’s palsy Tx? x3

A

A short course of steroid therapy (prednisone) and acyclovir, if necessary

Patient should wear an eye patch at night to prevent corneal abrasion

Surgical decompression of CN VII is indicated if the paralysis progresses or if tests indicate deterioration

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9
Q

Acute onset of focal neurologic deficits resulting from -

diminished blood flow

A

ISCHEMIC STROKE

Hemorrhage–> gic stroke

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10
Q

Contralateral paralysis, motor function

A

Right-sided symptoms = left side stroke, Left-sided symptoms = right-side stroke

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11
Q

Amaurosis fugax (monocular blind) which artery?

A

Carotid/ophthalmic

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12
Q

Aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia

A

Middle cerebral artery

MCA

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13
Q

Leg paresis, hemiplegia, urinary incontinence

A

ACA

Anterior

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14
Q

homonymous hemianopsia

A

Posterior cerebral artery

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15
Q

Coma, cranial nerve palsies, apnea, drop attach, vertigo

A

Basilar Artery

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16
Q

Silent, pure motor or sensory stroke, “Dysarthria-Clumsy hand syndrome”, ataxic hemiparesis

A

Lacunar infarcts occur in areas supplied by small perforating vessels and result from atherosclerosis, hypertension, and diabetes:

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17
Q

How to Dx stroke?

A

CT without contrast for acute presentation - important to diagnose as ischemic or hemorrhagic

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18
Q

How to treat stroke?

A

For occlusive disease treat with IV tPA if within 3-4.5 hours of symptom onset

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19
Q

When to consider intra-arterial thrombolysis?

A

in select patients (major MCA occlusion) up to 6 hours after onset of symptoms.

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20
Q

When to give warfarin/aspirin for stroke?

A

For embolic disease and hypercoagulable states give warfarin/aspirin once the hemorrhagic stroke has been ruled out.

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21
Q

When to perform endarterectomy?

A

Endarterectomy if carotid > 70% occluded

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22
Q

an acute cognitive dysfunction secondary to some underlying medical condition and is usually reversible

A

Delirium

Acute and rapid deterioration in mental status (hours-days), a fluctuating level of awareness, disorientation
Visual hallucinations are the most common type experienced by patients with delirium

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23
Q

Who are considered high risk for delirium?

A

High-risk after surgery especially in those with heart disease or diabetes
Delirium, unlike dementia, is usually reversible
Fall precautions - patients with delirium are six more times likely to fall

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24
Q

What is most common presentation of altered mental status in the inpatient setting

A

Delirium

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25
Q

most common cause of delirium, specifically, delirium tremens

A

Alcohol abuse

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26
Q

what are organic causes of delirium?

(like diseases) x 7

A

UTI, pneumonia, metabolic changes, CVA, MI, TBI, medications (anticholinergics, benzodiazepines, opioids)

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27
Q

Work up for delirium includes

x3

A

1st MMSE
2nd LABS: CMP, B12/folate

LP: if febrile, delirious patient (Cerebral edema)

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28
Q

when to give haldol in delirium patient?

A

for agitaiton/psychosis

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29
Q

What is second most common type of dementia? Stepwise deterioration with periods of clinical plateaus
May cause a sudden decline

A

Vascular disease
Associated with arteriosclerotic small vessel disease
Multi-infarct, usually correlated with a cerebrovascular event and/or cerebrovascular disease

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30
Q

How to treat vascular dementia?

A

Control the BP

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31
Q

Language difficulties, personality changes, and behavioral disturbances
Personality changes precede memory changes

A

frontotemporal lobar degeneration dementia

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32
Q

Hallucinations and delusions, gait difficulties, and falls

Parkinsonian symptoms

A

Lewy Body Disease

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33
Q

Cognitive decline associated with HIV infection
Substantial memory deficits, impaired executive functioning, poor attention and concentration, mental slowing, and apathy
Cerebral atrophy is typically evident on brain imaging

A

HIV dementia

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34
Q

what are the 4 main categories of dizziness?

A

Vertigo: False sense of motion, possibly spinning sensation

Disequilibrium: Off-balance or wobbly (up to 16%)

Presyncope: Feeling of losing consciousness or blacking out (up to 14%)

Lightheadedness: Vague symptoms, possibly feeling disconnected with the environment (approximately 10%)

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35
Q

episodic vertigo without hearing loss

Loose otolith in semicircular canals causing a false sense of motion
Positive findings with Dix-Hallpike maneuver (position changes)

A

Benign paroxysmal positional vertigo (vertigo)

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36
Q

Episodic vertigo, tinnitus, nausea, and hearing loss

Not associated with URI

MC in elderly and feeling of fullness in ear

A

Meniere disease (vertigo)

Increased endolymphatic fluid in the inner ear

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37
Q

Continuous vertigo. There is an absence of neurologic deficits

A

Labyrinthitis (vertigo)

Acute onset, vertigo, hearing loss, and tinnitus of several days to a week. Often preceded by a viral respiratory illness

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38
Q

Vertigo without position changes

No hearing loss or tinnitus (inflammation of the vestibular portion of CN VIII)

A

Vestibular neuronitis (vertigo)

Like labyrinthitis, it is often associated with a viral illness

39
Q

How to differentiate labrynthitis from vestibular neuronitis?

A

The features of acute labyrinthitis are similar to those of vestibular neuronitis, except labyrinthitis includes significant sensorineural hearing loss which is NOT present in vestibular neuronitis.”

Labrynthitis =significant sensorinural hearing loss

40
Q

Dysfunction in gait causing imbalance and falls

Shuffling gait with reduced arm swing and possible hesitation

A

Parkinson’s

41
Q

Decreased tactile response when walking causes the patient to be unaware when feet touch the ground, leading to imbalance and falls
Decreased sensation in lower extremities, particularly the feet

A

Peripheral neuropathy

42
Q

tremor - Hands and head
Shaking occurs with simple tasks such as tying shoelaces, handwriting, shaving or simply holding hands against gravity
Symptoms may be aggravated by stress, fatigue, caffeine, and temperature extremes
Better with alcohol

A

Intention/Action

Essential Tremor

43
Q

is essential tremor autosomal dominant or recessive?

A

: Family history, autosomal dominant. Elderly patients

44
Q

How to treat essential tremor?

x3

A

1st line
PROPRANOLOL

2nd line Primidone, alprazolam, small amounts of alcohol, gabapentin, topiramate, or nimodipine

Drug-resistant cases - Deep brain stimulation

45
Q

Unilateral, excruciating, sharp, searing, or piercing pain (often at night), lacrimation, and nasal congestion

Males > Females

A

CLUSTER HA
Treat with oxygen 100% at 6–12 L/min for 15 minutes via a nonrebreathing mask provides relief within 15 minutes and sumatriptan (Imitrex)

46
Q

A headache of varying intensity, often unilateral, and accompanied by nausea and sensitivity to light and sound

Pulsating, duration of 4–72 hours, unilateral, nausea, disabling, associated with photophobia and phonophobia

A

MIGRAINE

Without aura = most common, N/V, photophobia, phonophobia
Aura: scotoma, flashing lights, sound
HA follows aura w/in 30 min; visual = MC

47
Q

Migraine treatment:
x2
abortive

prophylaxis

A

Abortive: Triptans (do not use in ischemic heart disease), ergotamine (do not use in pregnant women)
Prophylaxis: Atenolol, propranolol, verapamil or TCAs

48
Q

Bilateral, squeezing sensation, mild to moderate, dull pain

Tx: x2?

A

Tension

whereas a migraine is typically pulsating; unilateral; and associated with nausea, vomiting, and photophobia or phonophobia

NSAIDS, muscle relaxer

49
Q

Caused by degeneration of basal ganglia in the substantia nigra leading to loss of dopamine-containing neurons located in the substantia nigra and locus coeruleus

A

Parkinson disease
REsting tremor

Lewy bodies

Acetylcholine/Dopamine imbalance

50
Q

What are the medications causing parkinson disease?

A

neuroleptics (chlorpromazine, metoclopramide, reserpine)

51
Q

Three cardinal features: Rest (pill-rolling) tremor, cogwheel rigidity, and bradykinesia (slowness of movement)

Other clinical features: Mask facies, loss of postural reflexes, decreased blink rate, shuffling gait, hypophonia, micrographia, gait arrest, and backward falling

A

PArkinsons

52
Q

Gold standard for Dx parkinson?

A

neuropathologic exam

MRI: for V Dz, tumor, or multiple system atrophy

53
Q

What is Tx for parkinson?

A

< 65 dopamine agonists: bromocriptine, pramipexole, ropinirole

Directly stimulates dopamine receptors. Fewer side effects than Levodopa. Used in younger patients to delay the use of Levodopa

54
Q

Treatment for restless leg syndorme?

A

Ropinirole

DA agonist

55
Q

Tx > 65 parkinsons?

A

Levadopa/carbidopa

56
Q

Side-effects of levodopa/carbidopa?

A

Common side effects of L-dopa: Gastrointestinal upset with nausea and vomiting, vivid dreams or nightmares, psychosis, and dyskinesias

57
Q

seizures with retained awareness (consciousness maintained)

A

This type of focal seizure was previously known as a simple partial seizure
No alteration in consciousness. Abnormal movements or sensations

58
Q

seizures with a loss of awareness (consciousness impaired)

Present with a postictal state (confusion and loss of memory) which differentiate them from absence seizures

A

This type of focal seizure may also be called a focal dyscognitive seizure (previously known as complex partial seizures)
Altered consciousness, automatisms (ie. Lip-smacking)

59
Q

what is treatment of focal seizures?

A

phenytoin, and carbamazepine are drugs of choice

60
Q

Characterized by a brief impairment of consciousness with an abrupt beginning and ending.

At times involuntary movements may occur, but they are uncommon and the patient has no recollection and witnesses commonly miss them

A

Absence seizures

Treat with ethosuximide or valproic acid.

61
Q

Bilaterally symmetric and without focal onset

Begins with a sudden loss of consciousness—a fall to the ground

A

Tonic clonic

Tonic phase: very stiff and rigid 10-60 seconds.
Clonic phase: generalized convulsions and limb jerking
Postictal phase: a confused state

62
Q

(also known as drop attacks)

Looks like syncope, sudden loss of muscle tone

A

Atonic seizure

fall like a tree

63
Q

Extreme rigidity then immediate LOC, but not followed by a clonic phase

A

Tonic seizure

64
Q

Muscle jerking, but not the tonic phase, occurs in the morning

A

myoclonic seizure

65
Q

Convulsion associated with an elevated temperature greater than 38°, > 6 mos < 5 years, absence of central nervous system infection or inflammation

A

FEbrile seizure

66
Q

Infantile spasms are a type of epilepsy seizure but they do not fit into the category of focal or generalized seizures

A

Infantile spasms

67
Q

a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them

A

Status epilepticus seizure

Two forms: convulsive and nonconvulsive
Convulsive status epilepticus presents with a regular pattern of contraction and extension of the arms and legs
Nonconvulsive status epilepticus includes complex partial status epilepticus and absence status epilepticus

68
Q

What is the prefered initial treatment for status epilepticus seizure?

A

Benzodiazepines
LORAZEPAM

after which PHENYTOIN

69
Q

a transient loss of consciousness/postural tone secondary to an acute decrease in cerebral blood flow
Characterized by a rapid recovery of consciousness without resuscitation

A

Syncope

70
Q

What are the 4 major categories of syncope you must rule out?

A

Cardiac syncope - arrhythmias
(e.g. AV block, sick sinus syndrome), -

obstruction of blood flow (e.g. aortic stenosis, hypertrophic cardiomyopathy), massive MI

Vasovagal syncope (neurocardiogenic) most common cause

Orthostatic hypotension - defect in vasomotor reflexes, common in elderly, diabetics, patients taking certain medications (e.g. diuretics, vasodilators)

Cerebral vascular disease - a rare cause of syncope
Other

71
Q

what are some non cardiogenic causes of syncope?

x4

A

noncardiogenic causes include metabolic causes
(e.g., hypoglycemia, hyperventilation), hypovolemia (e.g., hemorrhage),

hypersensitivity (syncope precipitated by wearing a tight collar or turning the head),

mechanical reduction of venous return (e.g., Valsalva maneuver, postmicturition),

various medications (e.g., β-blockers, nitrates, antiarrhythmic agents)

72
Q

A transient episode of neurologic dysfunction due to focal brain, retinal, or spinal cord ischemia without acute infarction

Sudden onset of neurologic deficit, lasting minutes to <1 h (15-30 min on average), a reversal of symptoms within 24 h

A

TIA Blockage in blood flow does not last long enough to cause permanent infarction

73
Q

Amaurosis Fugax (monocular vision loss - temporary “lampshade down on one eye”) weakness in the contralateral hand

Which artery is affected for TIA?

A

Internal carotid artery

74
Q

Cerebral hemisphere dysfunction. Sudden headache, speech changes, confusion

Which arteries? x3

A

ICA/MCA/ACA

75
Q

somatosensory deficit which artery?

A

PCA

76
Q

brainstem/cerebral symptoms (gait and proprioception)

A

Vertebrobasilar

77
Q

How to Dx TIA?

WORKUP for TIA?

A

CT (without contrast), MRI more sensitive, carotid doppler ultrasound to look for stenosis, CT angiography, MR angiography of the neck

78
Q

What to do with TIA? Tx options

A

Aspirin within 24 hours. Antiplatelet therapy (e.g., aspirin or clopidogrel or aspirin-dipyridamole) should be then initiated

79
Q

what to do for new-onset and recurrent TIA, unless a confident diagnosis of the cause of the event can be made

A

Admit to hospital

80
Q

what can help to distinguish central vs peripheral vertigo?

A

Duration and presence of hearing loss or nystagmus can help with diagnosis and differentiation between central vertigo and peripheral vertigo

81
Q 
Vertical nystagmus
No auditory symptoms
Gradual onset
Continous vertigo 
Nausea or vomiting

+ve Romberg sign

A

CENTRAL VERTIGO

82
Q

Causes of central vertigo?

x7

A
  • Medications
  • AV malformations
  • Brainstem vascular disease
  • brain tumor
  • head injury
  • multiple sclerosis
  • vertebrobasilar migraine
83
Q

Horizontal nystagmus

HEARING LOSS

Sudden onset,
intermittent N/V

A

Peripheral vertigo (inner ear)

84
Q

What are the causes of peripheral vertigo?

x5

A
  • Labrynthitis
  • BPPV
  • Endolymphatic hydrops aka MEniere syndrome
  • Vestibular neuritis
  • head injury
85
Q

What does it mean by non-fatigable nystagmus?

A

Central cause

can be elicited with dix-hallpike maneuver

86
Q

How to treat peripheral vertigo? BPPV

A

treat with Epley’s maneuver, vestibular suppressants help with acute symptoms: diazepam (Valium), meclizine

87
Q

hearing loss + continuous vertigo + URI

A

Labyrinthitis

88
Q

NO Hearing loss

+ vertigo
+URI

A

Vestibular neuronitis

89
Q

HEARING LOSS
+EPISODIC vertigo
+NO URI

A

Meniere disease

90
Q

NO HEARING LOSS

+EPISODIC Vertigo with
POSITION CHANGE

A

BPPV

91
Q

UNILATERAL hearing loss

Insidious onset vertigo & ATAXIA

+/- FACIAL NUMBNESS

A

Acoustic neuroma

92
Q

What are 6 reversible causes of Alzheimer’s disease?

A
  1. Secondary to an infection of the CNS (neurosyphilis)
  2. Metabolic and nutritional dementias (vitamin B12 deficiency)
  3. Inflammatory dementias (vasculitis involving cerebral blood vessels)
  4. Dementia caused by a structural defect impinging on the brain (a subdural hematoma or tumor)
  5. NPH
  6. Endocrine-related dementia (hypothyroidism)
93
Q

Different type of Alzheimer’s and specify which one when diagnosing.

A 
Alzheimer’s disease - slow decline in memory and ability to take care of oneself
Frontotemporal lobar degeneration
Lewy body disease
Vascular disease - sudden decline in mental status
Traumatic brain injury
Substance/medication use
HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease
94
Q

Initial eval of all patient with dementia screening study?

A 
CT
then MRI (expensive

Family Medicine EOR (4 decks)

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