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Emergency Medicine > Neurology > Flashcards

Neurology Flashcards

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1
Q

what are you assessing for in mental status evaluation?

A

oriented to person, place, and time

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2
Q

5 Major parts of Neuro exam

A 
mental status/ GCS
cranial nerves
motor/sensation
reflexes
cerebellar
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3
Q

Most common type of stroke

A

ischemic → 87%

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4
Q

Risk factors for stroke

A 
HTN 
DM
hyperlipidemia
obesity
smoking
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5
Q

sudden loss of blood circulation in brain resulting in ischemia and loss of neuro function

A

ischemic stroke

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6
Q

rupture of small blood vessels with bleeding inside parenchyma

A

hemorrhagic stroke

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7
Q

How do you differentiate between ischemic and hemorrhagic stroke?

A

Head CT

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8
Q

MC cause of hemorrhagic stroke

A

HTN

spontaneous rupture of Berry aneurysm/AVM due to infection, neoplasm

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9
Q

In acute setting, what type of stroke will you not see on CT?

A

ischemic stroke

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10
Q

Key sign/symptom of CVA/Tia

A

sudden onset

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11
Q

atypical presentation of CVA/TIA

A

subtle motor deficits, minimal ataxia, vague facial asymmetry

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12
Q

Most common symptoms of CVA/TIA

A

slurred speech, facial droop, unilateral weakness (UE/LE or both)

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13
Q

Other symptoms possibly seen with CVA/TIA

A

aphasia, dysphagia, ataxia, visual changes, memory loss, nause/vomiting

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14
Q

Timeline for resolution of TIA

A

80% resolve within 60 minutes

all resolve in 24 hours

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15
Q

CVA/TIA Differentials

A 
Bells Palsy 
hypoglycemia 
complex migraine 
hypertensive encephalopathy
labyrithitis/meniere's/BPV
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16
Q

when would you manage BP with CVA/TIA

if they are tPA candidate?

A

if >220/120

185/110

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17
Q

this type of stroke needs strike BP control

A

hemorrhagic stroke

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18
Q

Meds used to control BP

A

labetolol/nicardipine/nitroprusside

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19
Q

Timeframe where patient with CVA/TIA can be considered for tPA

A

less than 4.5 hours

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20
Q

With CVA/TIA if it has been less than 6 hours from last known normal, what therapy can you consider?

A

endovascular therapy → mechanical thrombectomy/intra-areterial tPA

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21
Q

First step in managing hemorrhagic CVA

A

stop/slow bleed → strict BP control → evacuation/coils/anti-coag reversal

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22
Q

Reversal for Warfarin/Coumadin

A

Vitamin K

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23
Q

Reversal for Heparin

A

Protamine

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24
Q

Potential reversals not NOAC (non-vitamin K Oral Anti-Coagulant)

A

rivaroxiban (Xarelto)

eloquiz (apixiban)

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25
Q

this bleed crosses suture lines and is usually venous blood

A

subdural hematoma

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26
Q

this bleed doesn’t cross suture lines and is usually arterial blood

A

epidural hematoma

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27
Q

MC traumatic head bleed

A

subdural hematoma

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28
Q

This is due to shearing force causing disruption of veins bridging brain and venous dural sinuses

A

subdural hematoma

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29
Q

Symptoms of subdural hematoma

A 
HA
Nausea/Vomiting
personality change 
decreased level of consciousness
speech difficulties 
impaired vision or double vision
weakness
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30
Q

Other signs present with subdural hematome related to trauma

A

basilar skull fracture
bilateral periorbital ecchymosis (raccoon eyes)
retroauricular ecchymosis (Battle sign)
presence of CSF rhinorrhea or otorrhea

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31
Q

What diagnostic test should you order for subdural hematoma?

A

Head CT without contrast

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32
Q

Elderly patient on blood thinners, what should you consider when ordering head CT?

A

delayed bleeds in anticoagulated patients

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33
Q

traumatic accumulation of blood between the skull and dural membrane

A

epidural hematoma

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34
Q

MC area for epidural hematoma

A

middle meningeal artery

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35
Q

Why is epidural hematome caught early have excellent prognosis?

A

underlying brain has usually been minimally injured

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36
Q

Classic presentation of epidural hematoma

A

Loss of consciousness
interval Lucid period
death

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37
Q

If you see dilated, sluggish or fixed pupils think….

A

heniation

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38
Q

“worse headache of my life”

A

subarachnoid hemorrhage

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39
Q

extravasation of blood into subarachnoid space between pial and arachnoid membranes

A

subarachnoid hemorrhage

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40
Q

most common cause of subarachnoid hemorrhage

A

trauma

also berry aneurysm or AVM

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41
Q

Thunderclap onset, severe headache, N/V, photo dizziness, seizure, meningismus

A

subarachnoid hemorrhage

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42
Q

this bleed has HIGH morbidity and mortality

A

subarachnoid hemorrhage

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43
Q

When is the best time to order CT head for SAH?

A

within 6 hours

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44
Q

If you are highly suspicious for SAH and negative head CT, what would you order?

A

LP → after 2 hours but < 24 hours

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45
Q

What will you see on LP for SAH?

A

XANTHOCHROMIA
non clearing RBC
elevated opening pressure

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46
Q

BP goal for SAH

Medications?

A

systolic between 110-150/MAP < 130

labetalol, hydralazine, nicardipine

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47
Q

Pain management for SAH

A

fentanyl > morphine/dilaudid

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48
Q

In SAH patient, what can you give to prevent vasospasms of cerebral arteries?

A

CCB → Nimodipine

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49
Q

In SAH patient, what do you give to decrease ICP?

A

Mannitol

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50
Q

what can mimic TIA/CVA?

A

complex migraine

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51
Q

Gradual onset, unilateral, throbbing/pulsatile

photophobia/hyperacousis, N/V

A

migraine

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52
Q

Treatment for Acute Migraine

A 
IVF
Benadryl
compazine
toradol
magnesium
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53
Q

Why do you avoid opioids with migraines?

A

cause reboudn headache

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54
Q

group of headaches lasting 15-180 minutes/episode, may be multiple a day

A

cluster headache

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55
Q

cluster headache lacks …

A

N/V
aura
photophobia

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56
Q

at least one of the following symptoms must be present for cluster headache

A 
rhinorrhea
nasal congestion
injection
facial swelling 
ptosis
miosis
eyelid edema 
lacrimation
57
Q

Treatment for cluster headaches

A

100% oxygen
triptan, DHE
No opioids

58
Q

systemic inflammatory vasculitis in temproal artery → older people

A

temporal arteritis (Giant Cell Arteritis)

59
Q

MC form of systemic vasculitits in adults?

Established risk factors?

A

temporal arteritis

age and female

60
Q

New presentation of HA or new type of HA in temporal or occipital area → throbbind and continuous pain

A

temporal arteritis

61
Q

Symptom highly predictive of temporal arteritis

A

jaw claudication

62
Q

Patient with Temporal Arteritis will have neck, shoulder, torso, and pelvic girdle pain consistent with ….

A

polymyalgia rheumatica

63
Q

New onset HA + 50 years or older + elevated ESR

A

Giant Cell arteritis

64
Q

Gold standard for diagnosing temporal arteritis

A

temporal artery biopsy

65
Q

Component usually seen with temporal arteritis

A

unilateral visual blurring or vision loss

66
Q

Laboratory hallmark for temporal arteritis

A

elevated ESR and C-reactive protein (CRP

> 50 mm/hr

67
Q

Management for patient presenting to ED with Temporal Arteritis

A

prednisone (temporal artery biopsy done within 1 week)

68
Q

Patients with Temporal Arteritis + Acute Visual Changes treatment?

A

methylprednisolone IV for 3 days

69
Q

treatment for steroid resistant cases of temporal arteritis

A

tocilizumab, cyclosporine, azathioprine, methotrexate

70
Q

cause of peripheral vertigo

A

vestibular apparatus malfunction → less concerning in ED

71
Q

cause of central vertigo

A

cerebellar or brain stem issue → bad

posterior circulation stroke, MS, tumor

72
Q

sudden onset + tinnitus + hearing loss + N/V + room spinning

A

peripheral vertigo

73
Q

ataxia/feel off balance + falls + “feel like wlaking drunk” + dysarthria + dysphagia + focal weakness

A

central vertigo

74
Q

suspect central vertigo, order?

A

MRI

CT not sensitive for posterior circulation

75
Q

Medical management for vertigo

A

antiemetic
meclizine/valium
IVF

76
Q

procedure that can be tried last resort to fix peripheral vertigo

A

Epley Menauver

77
Q

1 cause of encephalitis in US

A

Herpes Simplex Virus

78
Q

1 cause of encephalitis in immunocompromised patient

A

toxoplasmosis

79
Q

viral prodrome seen with encephalitis

A

several days of fever, HA, N/V, lethargy, myalgia

80
Q

behavioral/personality changes + decreased level of consciousness + neck pain/stiffness + photophobia + AMS + ataxia + CN defects + seizures + paralysis + dysphagia (particularly in rabies)

A

encephalitis

81
Q

this test is done on suspicious lesions for encephalitis

A

HSV culture → Taznck smear

82
Q

You see “ring enhancing lesion” on head CT

A

Encephalitis → due to toxoplasmosis

83
Q

diagnostic standard for encephalitis

A

brain biopsy

84
Q

Treatment for encephalitis

A

Acyclovir → especially if suspect it is in neonates

85
Q 
#1 cause of bacterial meningitis in adults 
#1 cause of bacterial meningitis ins kids
A

pneumococcal in adults

neisseria meningitides

86
Q

risk factors for meningitis

A

< 5 and > 60, immunocompromised, DM, CKD, trauma, alcoholism, IV drug abuse, endocarditis, VP shunt

87
Q

which is worse, bacterial or viral meningitis?

A

Bacterial → high morbidity/mortality

88
Q

Fever + AMS + HA + Neck stiffness

N/V, photophobia, nuchal rigidity, PETECHIAL rash, seizure

A

meningitis

89
Q

Key finding for meningitis in an infant

A 
bulging fontanelles 
(+ paradoxical irritability, hypotonia, poor feeding)
90
Q

Two positive signs for meningitis in infant

A

Kernig and Brudzinski

91
Q

first test to order if you suspect meningitis

A

CT of head → r/o bleed, mass, herniation

92
Q

diagnostic test for meningitis

A

lumbar puncture

93
Q

What are some other thing you may need to test for in HIV patient with meningitis?

A

CMV, cryptococcal

94
Q

order of testing and treating suspected meningitis

A

Blood culture → empiric antibiotics → CT and LB

95
Q

Antibiotics for meningitis in neonate

A

ampicillin
cefotaxime
gentamycin
AND acyclovir

96
Q

antibiotics for meningitis in 3 mo - 7 year old

A

cefotaxime
ceftriaxone
+/- Vanc

97
Q

antibiotics for meningitis in 7 - 50 year old

A

rocephin
Vanc
Ampicillin (if at risk for Listeria)

98
Q

Treatment for viral meningitis (HSV and CMV specifically)

A

supportive care
HSV → acyclovir
CMV → Ganciclovir/foscarnet

99
Q

treatment for fungal meningitis

A

amphotericin B

100
Q

What patients are brain abscesses more common in?

A

immunocompromised

101
Q

How do brain abscess symptoms differ from meningitis?

A

sinusitis or otitis 1-7 weeks prior

102
Q

Diagnostic test for brain abscess

A

CT Head with contrast

103
Q

Treatment for brain abscess

A

cefotaxime PLUS metronidazole

104
Q

Fever + midline back pain + neurological deficits → think?

A

epidural abscess

105
Q

High risk patients for epidural abscess

A

IV drug users !!
immunocompromised
recent surgery/procedure

106
Q

MC organism in epidural abscess

A

Staphylococcus aureus

107
Q

Early urinary sign for epidural abscess?

Late urinary sign for epidural abscess?

A

urinary retention → first

Incontinence → late

108
Q

gold standard for diagnosing epidural abscess

A

MRI with and without contrast

109
Q

Cause of Cauda Equina

A

compression of multiple lumbosacral nerve roots below the conus medullaris

110
Q

low back pain (radicular) + unilateral or bilateral sciatica + saddle and perineal hypoesthesia/anesthesia + bowel/bladder issues + loss of rectal tone

A

cauda equina

111
Q

Diagnostic test is confirmative of cauda equina

A

MRI

PVR for bladder dysfunction, poor DRE

112
Q

acute demyelinating neuropathy with preogressive ASCENDING SYMMETRICAL weakness → progresses over hours to days

A

Guillain-Barre Syndrome

113
Q

when will Guillain-Barre Syndrome present?

A

2-4 weeks after respiratory or GI illness

114
Q

How will symptoms of Guillain-Barre Syndrome present?

A

ascending and symmetrical

115
Q

Subtle + descending symptoms

A

epidural abscess

116
Q

Diagnostic test for Guillan Barre Syndrome ?

Descripotion of findings?

A

LP
Protein → elevated
glucose → normal
color → clear or xanthochromia

117
Q

Treatment of Guillan Barre Syndrome.

What should you not give?

A 
IV immunoglobulin (IVIG) OR plasma exchange 
NO steroids
118
Q

What do you want to order on patient with GBS?

A

PFT → get baseline to track

119
Q

Two types of seizures

A

generalized → tonic-clonic, grand mal

partial → localized to one area of the brain

120
Q

Two types of partial seizures

A

Simple → no LOC

Complex → altered LOC

121
Q

HTN + Edema + Proteinuria → 20 weeks to 8 weeks postpartum

A

eclampsia

122
Q

result of high body temperature but no underlying condition, self limited, 6 mo - 5 yr, MC in children

A

febrile seizures

123
Q

treatment of active seizure

A

protect airway + suction + roll onto side + IV ativan STAT + IVF + normal seizure med or Phenytoin

124
Q

what do all seizures have that pseudoseizures do not?

A

post-ictal state → amnesia, sleepiness, Ha, myalgia

125
Q

Patient present with new onset seizures → what do you think?

A

mass or trauma

126
Q

If you suspect exlampsia related seizure what do you administer?

A

IV magnesium

127
Q

1 cause of brekathrough seizure

A

noncompliance of meds

128
Q

Complications of Status Epilepticus

A

Hyperthermia, acidosis, hypotension, respiratory failure, rhabdomyolysis, aspiration

129
Q

criteria for Status Epilepticus

A

2+ seizures with incomplete recovery

130
Q

first line management of Status Epilepticus

A

Ativan

131
Q

Second and Third line management for Status Epilepticus

A

second → phenytoin or fosphenytoin

third → intubate, phenobarbitol

132
Q

Bell’s Palsy is dysfunction of ___

A

CN VII (Facial nerve)

133
Q

sudden symptom onset (48 hr) + symptoms on unilateral side + upper/mid/lower face

A

Bell’s Palsy

134
Q

1 cause of Bell’s Palsy

A

HSV infection

135
Q

Bell’s Palsy usually presents after a

A

URI

136
Q

How do you differentiate Bell’s Palsy from Stroke?

A

Stroke will SPARE the FOREHEAD

Bells palsy will NOT

137
Q

Deep ear pain and vesicular rash

A

Ramsay-Hunt

138
Q

duration of Bell’s Palsy

A

3 weeks - up to 6 months

139
Q

Treatment for Bell’s Palsy

A

prednisone

Emergency Medicine (6 decks)

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