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Neurology Flashcards

1
Q

occlusive stroke path

A 
thrombotic = plaque -> rupture
embolic = stroke from somewhere else (AFib, carotids fat, air)
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2
Q

occlusive stroke pt

A

focal neurologic deficit, acute
HTN, DM, obese, smoker, vascular disease (thrombotic)
young female with neck pain (dissection)
AFib with valvular disease (embolic)
Think FAST (face droop, arm drift, slurred speech, time and transport)

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3
Q

occlusive stroke dx

A

1st: CT scan (r/o bleed)
best: MRI (tPa before MRI if acute)

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4
Q

occlusive stroke tx

A

tPA

  • < 3hrs if diabetic
  • < 4.5hrs if not diabetic
  • NEVER brain bleed before
  • no recent GI bleed
  • no surgery within 21d
  • no trauma
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5
Q

occlusive stroke tx2:

A 
secondary prevention
aspirin first line
aspirin + dipyridamole if fails aspirin
clopidogrel if aspirin not tolerated
warfarin INR 2-3 if CHADS2 > 2 and AFib
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6
Q

occlusive stroke risk

A

statins, LDL <70, high-potency
insulin, HgbA1c < 7
ACE-I, BP <135/85

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7
Q

occlusive stroke f/u

A

Echo (TTE -> TEE), if clot, heparin -> warfarin

U/S carotid; >70% stenosis or symptomatic -> carotid endarterectomy….must wait weeks

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8
Q

hemorrhagic stroke path

A

hypertension

intraparenchymnal, subarachnoid

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9
Q

hemorrhagic stroke pt

A

focal neurologic deficit

worst headache of their life

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10
Q

hemorrhagic stroke dx

A

non-contrast CT = blood

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11
Q

hemorrhagic stroke tx

A

neurosurgery

MAP < 110

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12
Q

BP goals in stroke (24hrs)

A

stroke, tPA <180/110
stroke, no tPA < 220/120
hemorrhagic MAP < 110

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13
Q

posterior fossa tumor path

A

tumor

demyelinating diseases

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14
Q

posterior fossa tumor pt

A

NO ear symptoms

YES focal neurologic deficit (dizziness)

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15
Q

posterior fossa tumor dx

A

MRI MRA

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16
Q

posterior fossa tumor tx

A

control blood flow

resect tumor

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17
Q

benign paroxysmal positional vertigo path

A

otolith in semicircular canal

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18
Q

BPPV pt

A

recurrent and reproducible vertigo

< 1 min with head movement

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19
Q

BPPV dx

A

Dix-Hallpike = rotary nystagmus

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20
Q

BPPV tx

A

Epley maneuver (otolith repositioning)

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21
Q

Labyrinthitis/vestibular neuritis path

A

post-viral syndrome, usually URI

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22
Q

labyrinthitis/vestibular neuritis pt

A

weeks after URI presenting with vertigo, nausea/vomiting, tinnitus/hearing loss (loss specifically labyrinthitis)

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23
Q

labyrinthitis/vestibular neuritis dx

A

clinical, diagnosis of exclusion

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24
Q

labyrinthitis/vestibular neuritis tx

A

steroids, but only with 72hrs of onset, otherwise wait it out

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25
Q

meniere’s path

A

?

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26
Q

meniere’s pt

A

tinnitus, hearing loss, episodic vertigo

lasts > 30min

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27
Q

meniere’s dx

A

clinical

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28
Q

meniere’s tx

A

diuretic and low salt diet

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29
Q

grand mal seizure path

A

seizure, generalized, complex

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30
Q

grand mal seizure pt

A

convulsions = tonic clonic jerking

loss of consciousness

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31
Q

grand mal seizure dx

A

EEG

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32
Q

grand mal seizure tx

A

abort seizure = benzo

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33
Q

myoclonic seizure path

A

seizure, simple, partial

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34
Q

myoclonic seizure pt

A

spastic contractions

NO loss of consciousness

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35
Q

myoclonic seizure dx

A

EEG

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36
Q

myoclonic seizure tx

A

valproate

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37
Q

absence seizure path

A

seizure, partial, complex

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38
Q

absence seizuRe pt

A

maintains tone
loses consciousness - 100s of times per day
children
you think they are ADHD

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39
Q

absence seizure dx

A

EEG

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40
Q

absence seizure tx

A

ethosuximide or valproate

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41
Q

atonic seizure path

A

seizure, partial, siimple

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42
Q

atonic seizure pt

A

loses tone

maintains consciousness

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43
Q

atonic seizure dx

A

EEG

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44
Q

atonic seizure tx

A

valproate, helmets

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45
Q

trigeminal neuralgia path

A

seizure of trigeminal nerve

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46
Q

trigeminal neuralgia pt

A

lightning pain across the face, especially while chewing or drinking cold liquids

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47
Q

trigeminal neuralgia dx

A

EEG

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48
Q

trigeminal neuralgia tx

A

carbamazepine

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49
Q

status epilepticus path

A

sustained seizure

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50
Q

status epilepticus pt

A

continued seizure or failure or resolution or failure of post-octal state for 20mins

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51
Q

status epilepticus dx

A

EEG

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52
Q

status epilepticus tx

A

abort the seizure

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53
Q

status epilepticus path

A

VITAMINS vs epilepsy

non-compliance

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54
Q

status epilepticus pt

A

if after 20mins

  • uninterrupted seizure OR
  • failure to resolve post-ictal state
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55
Q

status epilepticus dx

A

if seizing, abort seizure first
EEG for seizure
check seizure medication levels
VITAMINS

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56
Q

status epilepticus tx

A 
for seizures
- lamotrigine
- valproate
- levitiracetam
for status
- IV Benzes, IV Benzos, IV benzos
- IV fosphenytoin
- IV phenobarbital
- IV midazolam and propofol
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57
Q

VITAMINS for seizures

A 
vascular - stroke, bleed
infection - encephalitis, meningitis
trauma - MVA, TBI
autoimmune - lupus, vasculitis
metabolic - Na, Ca, Mg, O2, glucose
idiopathic - 'everybody gets one' 
neoplasm - mets vs. primary
(p)sychiatric - faking it, iatrogenic
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58
Q

Parkinson’s path

A

loss of dopaminergic neurons in substantia nigra, loss of excitatory signal

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59
Q

parkinson’s pt

A

bradykinesia
cog-wheel rigidity
resting tremor
gait/postural instability

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60
Q

Parkinson’s dx

A

clinical

best: autopsy = Lewy bodies

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61
Q

parkinson’s tx

A

if > 70 or non-functional = levodopa-carbidopa
if < 70 and functional = ropinirole, pramipexole
add others as levodopa-carbidopa fails
-selegiline (MAO-B)
-Entacapone (COMT)
DBS

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62
Q

essential tremor path

A

familial

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63
Q

essential tremor pt

A

no tremor at rest, worsens with movement

males 40-60y/o

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64
Q

essential tremor dx

A

clinical

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65
Q

essential tremor tx

A

propranolol

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66
Q

cerebellar dysfunction path

A

cerebellar lesion = EtOH, CVA

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67
Q

cerebellar dysfunction pt

A

no tremor at rest

worsens with movement, gets worse with intention (closer you get, worse it gets)

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68
Q

cerebellar dysfunction dx

A

clinical

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69
Q

cerebellar dysfunciton tx

A

none

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70
Q

delirium tremens path

A

withdrawal from EtOH, benzos

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71
Q

delirium tremens pt

A

tremor at rest

anxiety, hallucinating, HTN, tachycardia

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72
Q

delirium tremens dx

A

clinical

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73
Q

delirium tremens tx

A 
oxazepam or chloridazepoxide (ppx)
lorazepam prn (tx)
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74
Q

huntington’s path

A

genetics, trinucleotide repeat, anticipation

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75
Q

huntington’s pt

A

chorea and dementia

76
Q

huntington’s dx

77
Q

huntington’s tx

78
Q

tension headache path

79
Q

tension headache pt

A

bilateral vice-like pain
temples that radiates to neck
worsens with exercise

80
Q

tension ha dx

81
Q

tension ha tx

A

OTC (acetaminophen)

82
Q

cluster ha path

A

vascular ha

83
Q

cluster ha pt

A

unilateral, lacrimation, ptosis, conjunctival injection

84
Q

cluster ha dx

85
Q

cluster ha tx

86
Q

cluster ha ppx

A

verapamil, diltiazem

87
Q

cluster ha f/u

A

one-time brain imaging MRI (MRI > CT) scan after attacks end

88
Q

migraines path

A

vascular, vasodilation

89
Q

migraines pt

A

photophobia, phonophobia
unilateral pounding headache
aborts with sleep, hangover the next day

90
Q

migraines dx

91
Q

migraines tx

A 
mild = NSAIDs
severe = ergots/triptans (caution CAD)
92
Q

migraines ppx

A

propranolol best

verapamil/diltiazem ok

93
Q

benign intracranial hypertension path

A

increased ICP

94
Q

benign intracranial hypertension pt

A

female on OCPs
HA worse in the morning
sounds like tumor

95
Q

benign intracranial HTN dx

A

CT r/o tumor
LP has elevated opening pressure
- relief of pressure = relief of symptoms

96
Q

benign intracranial HTN tx

A

stop OCPs

acetazolamide

97
Q

benign intracranial hypertension f/u

A

serial LP or VP shunt

98
Q

analgesic rebound headache path

A

withdrawal

99
Q

analgesic rebound ha pt

A

person who takes a bunch of pain meds and then stops

100
Q

analgesic rebound ha dx

101
Q

analgesic rebound ha tx

A

just get through it

102
Q

cord compression path

A

compression of spinal cord by any means - fx, mets, abscess

103
Q

cord compression pt

A 
neurologic compromise, back pain, and
hx of cancer
fever
urinary symptoms
sexual dysfunction
sensory deficit in dermatome
bilateral LE weakness
104
Q

cord compression dx

A

1st: xray spine
best: MRI spine

105
Q

cord compression tx

A

IV steroids, then dz specific

  • drain hematoma
  • I&D, abx for abscess
  • surgery/radiation for tumor
  • surgery for fx
106
Q

musculoskeletal back pain path

A

muscular strain

107
Q

msk back pain pt

A

patient has belt-like pain
no tenderness, no step-offs, no neuro signs
<40yo lifting heavy weights

108
Q

msk back pain dx

109
Q

msk back pain tx

A

NSAIDs and exercise

110
Q

herniation of disk path

A

nucleus pulposes

111
Q

herniation of disk pt

A

MSK +
- lightning pain that shoots down the leg with cough nd hip flexion
- straight leg raise elicits pain
- check for plantar flexion (L5, S1) or dorsiflexion (L4, L5)
unilateral

112
Q

herniation of disk dx

A

1st: xray
best: MRI

113
Q

herniation of disk tx

A

neurosurgery > conservative management at 6mo

the same at 1 yr

114
Q

osteophytes path

A

bone spurs pinch nerve at exit

115
Q

osteophytes pt

A

old guy, NO heavy lifting, but sounds like herniation

116
Q

osteophytes dx

A

1st: xray
best: MRI

117
Q

osteophytes tx

A

surgical removal

118
Q

compression fracture path

A

osteoporosis

119
Q

compression fx pt

A

old lady with a fall, falls on her butt
pinpoint tenderness
vertebral step-offs

120
Q

compression fx dx

A

1st: xray
best: MRI

121
Q

compression fx tx

A

surgery (laminectomy)

122
Q

compression fx f/u

123
Q

spinal stenosis path

A

canal is narrowed (idiopathic)

124
Q

spinal stenosis pt

A

buerning or lightning pain of thighs and buttocks that is worse when upright, better with leaning forward or climbing stairs

125
Q

spinal stenosis dx

A

1st: xray
best: MRI

126
Q

spinal stenosis tx

127
Q

spinal stenosis f/u

A

mimics claudication but has normal ABIs (pseudoclaudication)

128
Q

NPH path

A

normal ICP, but hydrocephalus

129
Q

NPH pt

A

wet, wobbly, and weird

130
Q

NPH dx

A

CT scan = hydrocephalus

LP = no increase ICP, but improvement of sxs

131
Q

NPH tx

A

serial LPs or VP shunt

132
Q

alzheimer’s path

A

plaques, tangles, chromosome 21

133
Q

alzheimer’s pt

A

insidious onset of progressive memory loss
short term first, then long term
sparing of social graces

134
Q

alzheimer’s dx

A

clinical

CT scan = cerebral atrophy

135
Q

alzheimer’s tx

A

supportive care, family education

anticholinesterase-I = donepezil, tacrine

136
Q

Alzheimer’s f/u

A

dies from something else

137
Q

Pick’s disease path

A

frontotemporal degeneration

138
Q

Pick’s disease pt

A

insidious onset of loss of personality and social graces

sparing of short term memory

139
Q

pick’s disease dx

A

clinical

CT scan = frontotemporal degeneration

140
Q

pick’s disease tx

A

none, palliative, institutionalized

141
Q

vascular dementia path

142
Q

vascular dementia pt

A

acute loss of memory or cognition in a step-wise fashion temporarily associated with stroke

143
Q

vascular dementia dx

A

CT/MRI = strokes

144
Q

vascular dementia tx

A

control risk factors for stroke

145
Q

Creutzfeldt-Jakob path

A

prions, spontaneous mutation&raquo_space; meat

146
Q

creutzfeldt-jakob pt

A

young, rapid dementia, myoclonus

147
Q

creutzfeldt-jakob dx

148
Q

creutzfeldt-jakob tx

A

none, palliative

149
Q

reversible causes of dementia

A

B12 deficiency
syphilis
hypothyroid
CKD

150
Q

tests to r/o reversible causes of dementia

A 
B12 level
RPR
TSH and T4
BUN/Cr
CT/MRI head
151
Q

coma path

A

decrease cerebral function (can come back)

toxic, metabolic

152
Q

coma pt

A

brain stem reflexes intact

depressed level of consciousness

153
Q

coma dx

A

EEG (decrease), reflexes intact, EKG normal

154
Q

coma tx

A

‘cocktail’ = naloxone, D50, thiamine

155
Q

persistent vegetative state path

A

no cerebral function (never coming back)

156
Q

persistent vegetative state pt

A

swallow, eat food, breathe on their own

157
Q

persistent vegetative state dx

A

EEG (decreased), reflexes intact, EKG normal

158
Q

persistent vegetative state tx

A

institutionalized care ,… peg and trache

159
Q

brain death path

A

brainstem and cerebrum are lost

160
Q

brain death pt

A

absent brainstem reflexes

161
Q

brain death dx

A

two separate physicians assess brainstem reflexes and show absence
trial of breathing without ventilator

162
Q

brain death tx

A

this person is dead, withdraw care

163
Q

locked in path

A

pontine stroke, intact cerebrum, intact heart, intact brainstem

164
Q

locked in pt

A

inability to move any part of their body

disconnect between brain and body

165
Q

locked in dx

166
Q

locked in tx

A

institutionalized care

167
Q

Lambert-Eaton path

A

paraneoplastic autoimmune disorder

antibodies against presynaptic calcium channels

168
Q

Lambert-Eaton pt

A

proximal muscle weakness

  • difficulty rising from chair
  • difficulty combing hair
169
Q

Lambert-Eaton dx

A

1st: antibodies
best: EMG
then: CT chest

170
Q

Lambert-eaton tx

A

chemo/surgery

azathioprine

171
Q

amyotrophic lateral sclerosis path

A

unknown, superoxide dismutase?

172
Q

ALS pt

A

both UMN lesion and LMN lesions
upper = hyperreflexia, positive babinski
lower = atrophy, fasciculation

173
Q

ALS dx

A

r/o spinal lesions = XR/CT/MRI

best = EMG

174
Q

ALS tx

A

none

‘riluzole’ (if you see this word, it’s ALS)

175
Q

MS path

A

autoimmune

demyelinating

176
Q

MS pt

A

neuro symptoms separated in both time and space

optic neuritis = blurry vision (painful)

177
Q

MS dx

A

1st and best = MRI with periventricular white lesions, demyelinating plaques

178
Q

MS tx

A

acute: methylprednisolone x5d
chronic: IFN + glatiramer, fingolimod
symptom control
- urinary retention = bethanechol
- urinary incontinence = amitryptiline
- spasms = baclofen
- neuropathic = gabapentin

179
Q

myasthenia gravis path

A

autoimmune

antibodies against ACh-R

180
Q

myasthenia pt

A

fatiguability of small muscles

blurry vision, dysphagia worse at end of day

181
Q

myasthenia dx

A

1st: antibodies
best: EMG
then: CT chest = thymic mass

182
Q

myasthenia tx

A

increase ACh with stigmine (neostigmine)
decrease autoimmune
- steroids >60, thymectomy < 60
- IVIG = plasmapheresis in acute crisis

183
Q

myasthenia f/u

A

edrophonium not used anymore

184
Q

Guillain-barre path

A

autoimmune

demyelinating

185
Q

Guillain-barre pt

A

ascending paralysis following diarrhea or vaccination

hyporeflexia, diaphragmatic paralysis

186
Q

Guillain-barre dx

A

1st: do they need intubation? … PFTs
then: LP = lots of protein, few cells
best: nerve conduction

187
Q

guillain-barre tx

A

IVIG = plasmapheresis

NEVER steroids

Online Med Ed (18 decks)

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