neurology Flashcards
What diagnosis should you consider in a patient with confusion and irritability after being in contact with a person with diagnosis of meningitis?
Enterovirus encephalitis
What diagnosis should you consider in a teenager who is unimmunized and presents with parotitis and neurological symptoms ?
Mumps encephalitis
What medication should you give in a febrile toddler who presents with a fever and lethargy for one hour post seizure?
Acyclovir and antibiotics
What is the treatment for a teenager with frontal headache which is “band like” and “pressure”?
Eliminating the environmental stressors
What is the first line treatment for migraine headache?
Ibuprofen
Tylenol
Fluids
Rest
What is the appropriate next step in a patient with several months of frontotemporal headache unrelieved wth daily Tylenol and Motrin ?
Stop medication as effect is blunted by chronic use
What diagnosis should you consider in a patient with headache and progressive and intermittent visual disturbances ?
Increased ICP
How can you differentiate migraines from increased ICP in a patient with headache and visual disturbances?
Migraines present with blurry vision only before the headache
Progressive visual loss is consistent with increased ICP
If a patient presents with abrupt onset of altered mental status what are the two most likely causes?
Trauma or CVA
If a patient presents with altered mental status that occurred over several hours, what is the more likely diagnosis?
Toxic ingestion
What is the probable diagnosis in a patient with hypoglycemia that is resistant to glucose replacement ?
Ingestion of hypoglycemic medication
If you are presented with a non responsive neonate, what labs should you order (other than to rule out sepsis)?
Ammonia
Organic acid levels
What diagnosis should you consider if you see greenish-yellow rings at the edge of the cornea on slit lamp exam?
Wilson’s disease
What are 4 abnormal lab results that help in diagnosis of Wilson’s disease?
Low ceruloplasmin
Low serum copper
Increased urinary copper
Hemolytic anemia
How would you treat Wilson disease ?
Penicillamine and low copper diet
What diagnosis presents as a neonate with hydrocephalus and hx of heart failure who has a cranial bruit on physical exam?
Vein of Galen malformation
What diagnosis should you consider in a patient with tremors, depression and abnormal eye movements as well as acute liver failure ?
Wilson’s disease
What are the 5 major causes of acute ataxia?
Toxic ingestion Infection Metabolic problems Trauma Neoplasm
What types of malignancy are patients with ataxia telangiectasia at risk for?
Hodgkin lymphoma and leukemia
What diagnosis should you consider in a patient with abnormal gait and abnormal pigmentation of the eyes?
Ataxia telangiectasia
Why do children with ataxia telangiectasia present with frequent upper and lower respiratory infections ?
Decreased levels of immunoglobulin and T cell dysfunction
What disease presents in late childhood with slow/clumsy gait as well as elevated plantar arch and absence of DTR in lower extremities?
Friedreich ataxia
Why do children with friedreich ataxia present with abnormal gait?
Cerebellar problem and loss of proprioception
What 2 (non neurological) problems are common in children with friedreich ataxia?
Diabetes
Cardiomyopathy leading to CHF
What is the treatment for friedreich ataxia?
Supportive
What diagnosis should you consider in a patient with quick random jerky movements and poor tone who has difficulty paying attention in school and emotional lability?
Sydenham chorea
What lab test effectively rules out Sydenham chorea?
None! A negative ASO does not rule out Sydenham chorea!!!
What is the treatment for Sydenham chorea?
Supportive Antipsychotics (dopamine blocking agents)
What is inheritance pattern of Huntington chorea?
Autosomal dominant
What is the classic triad of Huntington chorea?
Chorea
Hypotonia
Emotional lability (dementia)
What type of medication reaction should you consider in an alert patient with fixed upward gaze? How would you treat?
Dystonic reaction - treat with benadryl
What diagnosis and treatment would you provide to an ADHD child with brief episodes of eye blinking?
Simple motor tic - no intervention needed
What are choreiform movements?
Repetitive jerking movements that cannot be suppressed
What constitutes that diagnosis of Tourette syndrome?
Tic disorder present for at least one year
What are two things that were previously thought to cause tics but are now known not to be a cause of tics ?
Anxiety
Stimulant medications
What are 5 main classes of medications that cause tremors?
Methylxanthines (caffeine) Amphetamines Valproic acid Phenothiazine TCAs
What are the main symptoms associated with posterior fossa tumors?
Afebrile child with ataxia and headache
What diagnosis should you consider in a patient with growth delay, headaches and chronic progressive visual field deficits?
Craniopharyngioma (supratentorial tumor)
What Brain CT finding is seen in craniopharyngioma?
Calcification in sella turcica
What diagnosis should you consider in a patient with double vision, headache and papilledema?
Pseudotumor cerebri
What 5 types of medications can cause pseudotumor cerebri?
Vitamin A (megadoses) Steroids Thyroxine Lithium Antibiotics
What are 3 possible treatment options for pseudotumor cerebri?
Carbonic anhydrase inhibitor (acetazolamide)
Steroids
Shunt surgery
What should you be concerned about in a patient with HTN, bradycardia and abducens paresis?
Increased intracranial pressure
What are 3 contraindications to performing LP?
Focal neurological signs
Coagulapathy
Cardiorespiratory instability
What are 5 causes of acute peripheral nerve disorder with loss of deep tendon reflexes ?
Guillain barre Polio Diphtheria Tick paralysis Lead poisoning
What cause progressive onset of neuromuscular junction disorder? what causes a rapid onset NMJ disorder?
Myasthenia gravis (progressive) Botulism (rapid, descending)
What are 3 causes of chronic peripheral nerve disease and loss of deep tendon reflexes?
Chronic demyelinating poly neuropathy
Hereditary neuropathy
Leukodystrophy
What are 5 major causes of spinal cord weakness with loss of motor/sensation as well as loss of bladder/bowel function and increased reflexes?
Transverse myelitis Anterior spinal artery infarction Spinal cord compression Epidural abscess Tethered cord