Neurology Flashcards
Treatment of botulism entails:
- Respiratory support
- Trivalent botulinum antitoxin
- Admission
Carpal tunnel results from compression of the ___ nerve.
Median
- Women 30-55y
- *Signs: numbness and tingling of the thumb, index finger, middle finger, and medial half of ring finger. Nocturnal pain is common. Thenar atrophy in severe cases!
- **Tested with Tinel’s and Phalen’s signs
Compression of ulnar nerve at elbow is known as _____.
Cubital Tunnel
*Causes tingling in 5th and lateral 4th fingers that may progress to paralysis
Reactivation of HSV or VZV can cause facial paresis/inflammatory reaction involving the facial nerve. This is known as ____.
Bell’s Palsy
- RF- pregnancy and DM
- *S&S- facial paralysis, ptosis, ear pain, taste disturbance
ALS/Lou Gherig’s Disease associated with:
o Causes progressive muscle atrophy and weakness
o Upper motor neuron dysfunction causes limb spasticity, hyperreflexia, and emotional lability.
o Lower motor neuron dysfunction causes limb weakness, atrophy, fasciculations, dysarthria, dysphagia, and difficulty in mastication.
o Symptoms are asymmetric.
o Patients may appear to have an acute compressive radiculopathy.
o Respiratory muscle weakness causes progressive respiratory depression.
How is ALS managed?
o Respiratory failure, pneumonia, chocking, and trauma are common ED presentations.
o Optimize pulmonary function with nebulizer treatments, steroids, antibiotics, and intubation as indicated.
o Admit patients with pneumonia or inability to handle secretions.
Weakness of the proximal extremity muscles, neck, extensors, and facial muscles is most commonly seen with _______. Ptosis and diplopia are common presenting symptoms.
Myasthenia Gravis
______ test can differentiate myasthenic crisis from overmedication.
Tensilon
- Give neostigmine if positive
- *Crisis can lead to respiratory muscle weakness
MG treat with airway management and what other options?
High-dose steroids, plasmapheresis, IVIG
Decreased strength, increased tone, hyperreflexia, clonus, decreased vibratory sense and joint proprioception, and reduced pain and temperature sense are associated with what condition?
MS
Optic neuritis is a presenting complaint in 30% of ____ cases.
MS
High dose _____ has been shown to shorten duration of MS exacerbations.
Methylprednisolone
Resting tremor, cogwheel rigidity, bradykinesia, and impaired posture/equilibrium is associated with _____.
Parkinson’s Disease
*Resting arm tremor, pill rolling, which improves with intentional movement is also seen
Some info about migraines…
- Unilateral, with throbbing or pulsating discomfort.
- Triggers → chocolate, red wine, hard cheese, MSG, hormonal changes, exertion, fatigue, stress
- Often associated with N/V, photo and phonophobia
- Usually 4-72 hours in duration
Relief of migraines involves:
- Triptans. CI- CAD, PVD, pregnancy, uncontrolled HTN
- Dopamine blockers- Reglan, Phenergan, Compazine
* Given with Benadryl to prevent EPS - IV fluids, NSAIDs, and tylenol also help
- Prophylactic- beta blockers, calcium channel blockers, TCAs, NSAIDs, anticonvulsants
_____ is the MC type of HA.
Tension
- S&S- tight, band-like pain. Can be a constant, daily HA.
- *Not worsened with activity and usually not pulsatile
- **No N/V/FND
Severe unilateral, periorbital/temporal pain in bouts that last < 2 hours and may occur several times a day over 6-8 week period are known as _____ HAs.
Cluster
Ipsilateral Horner’s syndrome (ptosis, miosis, anhydrosis), nasal congestion/rhinorrhea, conjunctivitis and lacrimation are associated with _____.
Cluster headaches
____ is the 1st line treatment for cluster headaches.
100% Oxygen
- triptans can help during an attack
- *Verapamil for prophylaxis!!
Vibration and position sense in the toes test the posterior columns which degenerate in ____ and _____ deficiency.
Neurosyphilis and B12 deficiency
CT is less sensitive than Mr for lesions of the _____ and is insensitive for acute ischemia.
Posterior fossa
Neurosyphilis is screened for with the ___ and ____ tests.
VDRL and RPR
Suspect _____ in an elderly patient with a broad-based, shuffling gait, urinary incontinence, and dementia. CT will show–> ventricular dilatation out of proportion to sulcal atrophy.
Normal pressure hydrocephalus
Administer _____ IV to alcoholics and other malnourished individuals who might have Wernicke disease, which is suggested by findings of ataxia, AMS, and ophthalmoplegia.
Thiamine