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Primary Care > Neurology > Flashcards

Neurology Flashcards

1
Q

Vertigo that is episodic with no hearing loss is known as _____.

A

Benign Paroxysmal Positional Vertigo

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2
Q

Vertigo that is episodic with hearing loss is known as _____.

A

Meniere’s Disease

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3
Q

Vertigo that is continuous with no hearing loss is known as _____.

A

Vestibular Neuritis

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4
Q

Vertigo that is continuous with hearing loss is known as _____.

A

Labyrinthitis

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5
Q

Peripheral vertigo is assoc. w/ ____ (horizontal/vertical) nystagmus while central causes of vertigo are associated with ____ (horizontal/vertical) nystagmus.

A

Peripheral- Horizontal–> fatigable

Central- Vertical–> NONfatigable

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6
Q

_____ is caused by displaced otoliths and is the MC cause of vertigo.

A

BPPV

  • Attacks last 10-60 seconds
  • *Dx: Dix-Hallpike Test
  • **Treatment: Epley maneuver, antihistamines
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7
Q

Vestibular neuritis is most likely to occur after a ____ infection.

A

Viral

*Inflammation of vestibular portion of CN8

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8
Q

1st line treatment for Vestibular Neuritis and Labyrinthitis is:

A

CORTICOSTEROIDS, if symptomatic then Meclizine

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9
Q

Episodic vertigo that lasts 1-8 hours w/ horizontal nystagmus, N/V, tinnitus, and fluctuating hearing loss is known as _______.

A

Meniere’s Disease

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10
Q

Diagnosis of Meniere’s is done with:

A

Transtympanic electrocochleography- most accurate test during an active episode

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11
Q

Treatment of Meniere’s:

A

Symptomatic

  • Decompression if refractory to meds or severe
  • Preventative: HCTZ, AVOID salt/caffeine/chocolate/ETOH

(Meniere SYNDROME is due to identifiable cause; Meniere DISEASE is idiopathic)

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12
Q

What are some nonvertiginous causes of dizziness?

A
  1. Disequilibrium: visual or MSK d/o, neuropathies, anxiety/depression
  2. Presyncope: sensation that LOC is imminent; caused by dec. cerebral perfusion- usually orthostatic hypotension or vagally mediated cardiac events
  3. Light-headedness: vague sensation and often psych in origin; tx- trial of antidepressants
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13
Q

What are some common causes of syncope?

A

Arrhythmias, aortic stenosis, carotid sinus hypersensitivity, MI, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, PE, vagal faint

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14
Q

How is syncope worked-up?

A

EKG, Holter, echo, tilt-table test, electrophysiologic studies, CT or MRI of brain

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15
Q

Partial seizures are confined to 1 hemisphere. _____ is a type in which consciousness if fully maintained. There may be a transient neuro deficit (Todd’s paralysis) lasting up to 24 hours.

A

Simple partial

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16
Q

_____ is a type of partial seizure in which consciousness is impaired. There are auras and automatisms.

A

Complex partial

*Automatisms: lip smacking, manual picking, patting, coordinated motor movement

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17
Q

_____ is a type of seizure that is associated with a brief lapse in consciousness, staring episodes, and eyelid twitching. MC in childhood and usually stops by 20y.

A

Absence (Petit Mal)

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18
Q

______ is associated with LOC and rigidity followed by repetitive, rhythmic jerking for <2-3 min.

A

Tonic-Clonic (Grand Mal)

  • Post-ictal phase= flaccid coma/sleep of variable duration
  • *May have incontinence, tongue biting, or aspiration
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19
Q

_____ is associated w/ sudden, brief, sporadic involuntary twitching. No LOC.

A

May be 1 muscle or groups of muscles

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20
Q

Otherwise known as “drop attacks”:

A

Atonic

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21
Q

______ are repeated, generalized seizures without recovery for >30min.

A

Status epilepticus

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22
Q

______ is a 1st line treatment for Absence seizures.

A

Ethosuximide

*Caution- renal/hepatic failure

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23
Q

Treatment for Grand Mal includes what options (name 4)?

A

Valproic acid, Phenytoin, Carbamazepine, Lamotrigine

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24
Q

The treatment of Status Epilepticus is Lorazepam/Diazepam –> Pheytoin –> _______

A

Phenobarbital

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25
Q

_____ is DOC for febrile seizures in kids.

A

Phenobarbital

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26
Q

____ levels are increased in seizures (helps to differentiate between pseudoseizures).

A

Prolactin

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27
Q

Pancreatitis, hepatotoxicity, and thrombocytopenia are associated with what seizure medication?

A

Valproic acid

*Caution- hepatic disorders

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28
Q

SJS is associated with what seizure med?

A

Lamotrigine

29
Q

____ can be given for seizure prophylaxis. It is also the second drug given (after BZD) in episodes of status epilepticus.

A

Phenytoin

*ADRs- gingival hyperplasia, hirsutism, hypotension, arrhythmias

30
Q

Seizures, bipolar disorders, and TRIGEMINAL NEURALGIA can be treated with ____.

A

Carbamazepine

*ADRs- HYPOnatremia, SJS

31
Q

Topiramate can be associated with what unique ADRs?

A

Wt loss, Nephrolithiasis

32
Q

TIA often last < ___ (time frame). Most resolve in __ to __ (time frames).

A

Last < 24hr and most resolve in 30-60min

33
Q

___% of patients with TIA will have a CVA in 1st 24-48h afterwards.

34
Q

Probs w/ gait, proprioception, dizziness, and vertigo are associated with what TIA etiology?

A

Vertebrobasilar

35
Q

How are TIAs worked up?

A
  1. CT scan of head to r/o bleed
  2. Carotid doppler
  3. CTA, MRA, Transcranial doppler
  4. Glucose to r/o HYPOglycemia, also r/o: electrolyte abnormalities, coag probs, and get CBC
  5. Echo: TTE or TEE to look for cardioembolic sources
  6. ECG: to look for A. fib
36
Q

How are TIAs treated?

A

ASA +/- Dipyridamole or Clopidogrel (Plavix)

*Thrombolytics are contraindicated!!

37
Q

MC type of ischemic CVA occurs in what area of the brain?

A

Middle cerebral artery- Anterior circulation

38
Q

____ is the inability to sensibly put words together and ____ is the inability to understand speech.

A

Broca’s aphasia- can’t put words together

Wernicke’s aphasia- can’t understand speech

39
Q

How are CVAs diagnosed?

A

CT scan (may be normal in first 6-24h)

40
Q

How are ischemic strokes treated?

A

Lacunar- ASA–> good prognosis

  1. Thrombolytics- w/in 3 hours. CI if BP >185/110, recent bleed/trauma, bleeding d/o
  2. Antiplatelet therapy- ASA, Plavix, Dypyridamole
  3. Anticoag if cardioembolic
41
Q

Strokes with facial involvement can still raise BOTH eyebrows!!!

42
Q

Hemorrhagic strokes account for __% of strokes. They include spontaneous ICH and SAH.

A

20%

*Spontaneous ICH- MC from HTN. Treatment is supportive v. hematoma evacuation. Elevate head and mannitol!

**SAH- MC secondary to ruptured Berry aneurysm

43
Q

How is a Berry Aneurysm diagnosed?

A

Angiography

44
Q

____ is a transient confused state due to an identifiable cause. Usually associated with full recovery within 1 week in most cases.

45
Q

______ is associated with MEMORY LOSS and loss of impulse control, motor and cognitive functions.

A

Dementia

*RF: age >60y and vascular dz

46
Q

____ is the MC type of dementia. Associated with tau protein deposition.

A

Alzheimers

47
Q

How is Alzheimers diagnosed?

A

CT scan of brain usually reveals cerebral cortex atrophy

48
Q

How is Alzheimers treated?

A
  • Ach-esterase inhibitors- Donepezil (Aricept)= doesn’t slow progression
  • NMDA antagonist: Memantine= reduces glutamate excitotoxicity
49
Q

_____ dementia is 2nd MC type and is associated with chronic ischemia and multiple infarctions (lacunar).

A

Vascular dementia

*HTN control may slow progression

50
Q

____ dementia is associated with marked personality changes and new behavioral symptoms such as apathy and disinhibition. Usually NO AMNESIA is present.

A

Frontotemporal dementia

*(+) Pick bodies

51
Q

______ is associated with abnormal neuronal protein deposits in the brain. Symptoms include visual hallucinations, delusions, episodic delirium, and Parkinsonism.

A

Diffuse Lewy Body Disease

52
Q

RESTING tremor is MC sign of _____ disease. Onset of symptoms is usually between 45y-65y.

A

Parkinson’s

*Loss of pigment cells seen in substantia nigra

53
Q

Other S&S of Parkinson’s include:

A

Bradykinesia w/ lack of swinging arms and shuffling gait, Rigidity- increased resistance to passive movement, Fixed facial expressions, Instability

54
Q

Treatment options for Parkinson’s include:

A
  1. Levodopa + Carbidopa–> Levodopa is converted to dopamine. Carbidopa reduces the amount of Levodopa needed (reducing ADRs of Levodopa)
  2. Dopamine agonists= Bromocriptine, Pramipexole, Ropinirole
  3. Anticholinergics= Benztropine (Cogentin)
  4. Amantadine
55
Q

______ is an INTENTIONAL TREMOR, with an age of onset typically around 60.

A

Essential Familial Tremor

  • MC in UE and head
  • *Worsened w/ emotional stress
56
Q

What are treatment options for intentional tremor?

A
  • Propranolol may help if severe or situational
  • Primidone (barbiturate) if no relief from Propranolol
  • Alprazolam- 3rd line
57
Q

____ is idiopathic, unilateral CN VII/facial nerve palsy. ONLY affects the face, not extremities.

A

Bell’s Palsy

*Strong association with HSV reactivation

58
Q

RF for Bell’s Palsy include:

A

DM, pregnancy (esp 3rd trimester), post URI, and dental nerve block

59
Q

Remember…if able to lift BOTH eyebrows it is NOT Bell’s Palsy

A

to distinguish from CVA

60
Q

Treatment for Bell’s Palsy includes:

A

No treatment required, silly! Most cases resolve in 1 month. However…

  1. Prednisone can help decrease nerve inflammation (esp in 1st 72 hours)
  2. Artificial tears to replace lacrimation and help with vision probs
  3. Acyclovir has been shown to improve symptoms/timing of recovery
61
Q

Be suspicious of HA that are abrupt or quickly progress in severity.

A

Meningitis, SAH, intracranial HTN, HTN crisis, acute glaucoma

62
Q

_____ HAs are MC overall type and are NOT worsened by activity.

63
Q

____ is MC cause of morning headache. It is LATERALIZED, pulsatile, assoc. with N/V, photophobia and phonophobia. Usually 4-72h in duration.

A

Migraine

*Worse with physical activity

64
Q

How are migraines managed?

A
  1. Triptans or Ergotamines
  2. Dopamine blockers- Reglan, Phenergan. If giving these antiemetics for N/V you want to give with Benadryl to prevent EPS, dystonic rxns, and parkinsonism symptoms due to decreased dopamine.
65
Q

Prophylactic treatment for migraines=

A
  • Anti-HTN meds: BB, CCB
  • TCAs
  • Valproate, Topiramate
  • NSAIDs
66
Q

____ HA are seen mostly in young & middle-aged men. They are described as severe UNILATERAL periorbital/temporal pain that is sharp and lasts <2h. They occur several times a day over 6-8 weeks.

A

Cluster

*Triggers: worse at night, ETOH, stress, certain foods

67
Q

What is Horner’s syndrome? (can be seen w/ cluster HA)

A

Ptosis + Miosis + Anhidrosis

  • SEEN IPSILATERALLY
  • *Also- nasal congestion/rhinorrhea, conjunctivit, lacrimation
68
Q

How are cluster HA treated?

A

100% O2

*Prophylaxis- Verapamil 1st line!

Primary Care (12 decks)

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