Neurology Flashcards
What are some signs of dangerous headaches
Thunderclap headache, worst headache of my life, first onset of headache age 50
A headache with papilledema is indicative of
Increased intracranial pressure
Acute onset of high fever, severe headache, and stiff neck is indicative of
Acute bacterial meningitis
Is acute bacterial meningitis a reportable disease
Yes if not treated it is fatal
If you find an absent red reflex on a funduscopic exam this indicates
Cataracts
If you find an abnormal Cop disk ratio of greater than 0.5, this indicates
Glaucoma
If you find absent venous pulsations on a fundoscopic exam, this indicates
Papilledema
If you find blood in the center of the optic disc in a funduscopic exam this indicates
Subarachnoid hemorrhage
Which imaging study looks at cavities
CT
Which imaging exam looks at soft tissue
MRI
Which imaging study looks at the heart of things such as bone
CT
Which imaging study looks at the brain, spinal cord, ligament, tendon injuries, soft tissue and tumors
MRI
Which imaging study emits radiation
CT
which imaging study does not emit radiation
MRI
Absolutely no contrast in an imaging study when there is a suspected
Bleed
When should you use contrast in a CT scan
When you were looking at phone plus surrounding soft tissue including blood vessels
When should you use contrast in an MRI
When you want to discriminate between types of soft tissue
What is the imaging study of choice when Neuro imaging is needed
CT with or without contrast
When is an MRI indicated for neuro imaging
With posterior fossa lesions or if CSF leak is suspected
Acute onset of headache that is located on one temple on an older adult. The affected temple has an indurated, reddened, and cord like temporal artery that is tender to touch and accompanied by scalp tenderness. What is this disease
Temporal arteritis
Can temporal arteritis cause blindness and visual disturbances
Yes
Jaw pain or jaw claudication is associated with
Temporal arteritis
What neurological condition would give you markedly elevated sedimentation rate and C reactive protein
Temporal arteritis
Patients with polymyalgia rheumatica all right a high risk of developing which neurological condition
Temporal arteritis
Acute onset of headaches behind an eye or around one eye accompanied by eye pain, blurred vision, and nausea or vomiting. The cornea looks hazy and the affected pupil is dilated midway. This condition is most common in older adults.
Acute narrow angle closure glaucoma
A patient with risk factors for embolization such as A Fib, or prolonged immobilization presents with acute onset of stuttering/speech disturbance, one sided facial weakness and weakness of the arms and or legs i.e. hemiparesis.
Embolic stroke
Patient presents with poorly controlled hypertension and an abrupt onset of a severe headache, nausea/vomiting, and nuchal rigidity
Hemorrhagic stroke
Nuchal rigidity indicates
Sub arachnoid bleed
A patient with a history of head trauma presents with a history of headaches and gradual cognitive impairment. This condition is most common in the elderly and those who are on anticoagulation or aspirin therapy. The area of bleeding is between the Dora and subarachnoid membranes of the brain
Chronic subdural hematoma
Sudden onset of severe headache described as the worst headache of my life, accompanied by photophobia, nausea/vomiting, meningeal irritation, and positive Brudzinski and Kernig signs with a rapid decline in level of consciousness
Subarachnoid hemorrhage
How do you assess mental status
Mini mental exam, cranial nerve exam
What does the mini mental exam consist of
Orientation, registration, attention and calculation, spell world backwards or serial sevens, language, look for aphasia or difficulty speaking
In what neurological test do you tell the patient to stand with their arms and hands straight on each side and with their feet together with their eyes closed.
Romberg test
Ability to recognize familiar objects through sense of touch only
Stereo gnosis
Ability to identify figures written on the skin with eyes closed
Graphesthesia
What two tests are used to assess for meningitis
Kernig’s sign and Brudzinski’s sign
In which test do you flex the patients hips one at a time then attempt to straighten the leg while keeping the hip flexed at 90°
Kernig’s sign
What test do you possibly flex and bend The patient’s neck toward the chest
Brudzinskis sign
if you tell the patient to touch their chest with their chin and they are unable to touch that test this is a positive finding of
Nuchal rigidity
What cranial nerve is for shoulders shrugging together
11
Spinal accessory
What viral infection can result in corneal blindness
Herpes zoster infection ID shingles
What cranial nerves does the herpes zoster infection i.e. shingles
Cranial nerve number five i.e. trigeminal
If there is a rash at the tip of the nose and the temple area what infection must be ruled out
Shingles infection of the trigeminal nerve
What diagnostic testing is needed for acute bacterial meningitis
Lumbar puncture, CT or MRI, CVC and Gram stain of CSF fluid and the blood before antibiotics
How is acute bacterial meningitis treated
Third generation cephalosporin plus chloramphenicol
What is the prophylaxis of close contacts for a patient with acute bacterial meningitis
Rifampin or ceftriaxone
What are Blindspot on the visual field
Scotland
When a child presents with abdominal pain what type of headache should be considered
Migraine headaches
An adult female complains of a gradual onset of a bad throbbing headache behind what I that gradually worsened over several hours. Reports sensitivity to bright light and noise and nausea and vomiting
Migraine
What is hyperosmia
Smell
What type of medications are used to abort a migraine headache
Triptans
If a migraine medication is not a triptan (abortive), then it is
Prophylactic
Can a patient with migraine with aura be prescribed oral contraceptives
No
At what age should the patient with migraines stop oral contraceptives
35
Can triptans lead to rebound headaches is overused
Yes
Prophylactic treatment for migraines should be used how often per month
Greater than or equal to two per month
A headache that is unilateral, bifrontal, or global, and has a crescendo pattern, patient desiring a cool, quiet, dark room. Duration for 4 to 72 hours with nausea, vomiting, photophobia, and possible aura
Migraine headache
This headache is bilateral, described as a pressure headache with tightness and bandlike and waxes and wanes. Patient May continue days activities or not. But the duration varies
Tension headache
This headache is always unilateral and begins around the temple or eye. The pain is described as excruciating and explosive but peaks within minutes. The duration is 30 to 90 minutes usually and the eye becomes red, teary, rhinorrhea and alcohol can be a trigger
Cluster headache
Nasal stuffiness is associated with
Sinusitis
Draw claudication with chewing, fever, visual loss, pain in temple area is associated with
Temporal arteritis
Visual field defect is associated with
Optic pathway lesion or pituitary tumor
Blurred vision on bending of the head is associated with
Intracranial lesion
Headache with nausea and vomiting is associated with
Tumor
Unilateral vision loss is associated with
Optic neuritis
Sweating and tachycardia is associated with
Pheochromocytoma
Transient visual changes and intracranial noise is associated with
Pseudotumor cerebrii
Wasn’t migraine headache do you treat prophylactically or abortive first
NSAIDs
Neurological exam will be normal with what type of headache
Migraine
If a patient has a history of cardiovascular disease, or uncontrolled hypertension this patient would not be able to take what type of migraine medication
Five HT one agonists such as sumatriptan
Flashing, tingling, chest/neck/sinus/jaw discomfort are all side effects of what type of migraine medication
Sumatriptan
What type of migraine medication puts a patient at higher risk of serotonin syndrome if combined with an SSRI or SNRI
Sumatriptan
Which neurological condition is associated with intense and very brief sharp stabbing pain in one cheek
Trigeminal neuralgia cranial nerve five
If a patient is on Ergotamine/caffeine, what other migraine headache should be avoided
Sumatriptan and decongestants
How does ergotamine/caffeine work
Potent vasoconstrictor
Common side effect is nausea
If a patient has hyperlipidemia, hypertension uncontrolled, or complex migraines, is a male over 40 years of age, or a menopausal female, what types of medications should be avoided
Vasoconstricting drugs such as sumatriptan or ergotamine/caffeine
Focal neurologic findingsin the cranial nerve exam with strokelike signs and symptoms resembling a TIA is consistent with what type of migraine
Basilar or hemiplegic migraine’s
And what type of migraine is a patient at a higher risk of stroke. You should also avoid giving estrogens or any agents probably clot formation these patients
Hemiplegic or basilar migraines
Acute onset of a unilateral headache that is located on the temple and is associated with temporal artery inflammation
Temporal arteritis or giant cell arteritis
What condition is a systemic inflammatory disorder i.e. vasculitis of the medium and large arteries of the body was the median diagnosis age of 72 years old
Temporal arteritis or giant cell arteritis
Can temporal arteritis lead to blindness
Yes
The patient comes in and complains of a headache on their temple along with marked scalp tenderness on the same side, presence of an indurated cordlike temporal artery that is warm and tender, and jaw claudication, which condition is this indicative of
Temporal arteritis or giant cell arteritis
If a patient complains of amaurosis fugax or blindness and an increased sedimentation rate, what disorder should be in the differential
Temporal arteritis or giant cell arteritis
What labs should you check for temporal arteritis
ESR and CRP
How do you treat temporal arteritis or giant cell arteritis
Refer to ophthalmologist or refer to ED stat
What is the gold standard test for temporal arteritis
Temporal artery biopsy
What is the treatment choice for temporal arteritis
High dose steroids are first line treatment prednisone 40 to 60 mg PO daily for several weeks
What is the screening test for temporal arteritis
Sedimentation rate
Patients with what disease are at a very high risk for developing temporal arteritis
Polymyalgia rheumatica
Bilateral morning stiffness and aching located in the shoulders, neck, hips, and torso, found mostly in females over the age of 50. What are these side effects of
Polymyalgia rheumatica
How do you treat polymyalgia rheumatica
Oral steroids
An older patient complains of the sudden onset of severe and sharp shooting pain on one side of her face or around the nose that are triggered by chewing, eating cold foods, and cold air. The pain can be severe and last a few seconds. What condition is this
Trigeminal neuralgia
How is trigeminal neuralgia treated
High doses of anti-convulsant such as carbamazepine or phenytoin.
Abrupt onset of unilateral facial paralysis due to dysfunction of the motor branch of the facial nerve
Bell’s palsy
In what condition can tear production on the affected side of the face stop
Bells palsy
Which condition can spontaneously resolved, and the etiology ranges from viral infection, and autoimmune process, or pressure from a tumor or a blood vessel
Bells palsey
An older adult reports waking up that morning with one side of their face paralyzed. Complains of difficulty chewing and swallowing food on the same side. Unable to fully clothes eyelids
Bell’s palsy
In what condition do you rule out stroke, TIA, mastoid infection, bone fracture, Lyme disease, and tumor
Bell’s palsy
How do you treat bells palsy
Corticosteroids at high doses times 10 days, acyclovir if herpes Symplex is suspected. Protect cornea from drying and ulceration with applications of an eye lubricant b.i.d. patch I if patient is unable to fully close the eyelid
Corneal ulcer ration and permanent and neurological symptoms such as facial weakness can occur from prolonged cases of
Bell’s palsy
And idiopathic and severe one sided headache that is marked by Richard episodes of brief ice pick lacerating pain located behind one eye that is accompanied by tearing and clear rhinitis
Cluster headache
Ptosis or drooping eyelids are associated with which type of headache
Cluster headache
What type of headache is more common in adult males in their thirties to 40s
Cluster headache
What is the treatment plan for cluster headaches
High dose oxygen, do not use on COPD patients.
Triptans injections or intranasal
Prophylaxis: verapamil PO daily
What type of headache is linked to a higher risk of suicide in males compared with other types of chronic headaches
Cluster headache
Bilateral headache
Tension headache
