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Internal Medicine EOR > Neurology > Flashcards

Neurology Flashcards

1
Q

Bells Palsy etiology

A

idiopathic, U/L CN VII facial nerve palsy

Hemifacial weakness and paralysis

Strong association with HSV reactivation

Rsk Factors: DM, prego, post URI, dental nerve block

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2
Q

Bells Palsy manifestation

A

Ipsilateral ear pain for 24-48 hrs: Unilateral facial paralysis
Unable to life eyebrow

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3
Q

Bells Palsy Tx

A

None required
Prednisone decreases nerve inflamm if started within 1st 72 hours of sx

Artificial Tears, eye patch

Fxn returns within 2 weeks with significant improvements within 4 months

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4
Q

TIA sx

A

Monocular vision loss “lamp shade down one eye”

weakness, speech change, confusion

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5
Q

TIA Dx

A

CT initial TOC

W/O contrast to r/o hemorrhage

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6
Q

TIA tx

A

ASA and Plavix
Thrombolytics contraindicated
Place in supine position

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7
Q

Subclavian Steal Syndrome

A

Signs and sx from reversed blood flow down the ipsilateral vertebral artery to supply the affected due to occlusion or stenosis of subclavian artery

LEFT ARM MC

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8
Q

Subclavian Steal Syndrome manifestations

A

RISK: arthrosclerosis

Paresthesia, claudication, blood pressure difference in each arm, nystagmus, weakness, syncope

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9
Q

Subclavian Steal Syndrome Dx

A

Continuous wave doppler

Tx: revascularization or Percutaneous transluminal angioplasty

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10
Q

Acoustic Neuroma etiology

A

CN VII shwannoma: benign tumor of schwann cells which produce myelin sheath

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11
Q

Acoustic Neuroma sx

A

Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise, tinnitus, HA, facial numbness, vertigo

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12
Q

Acoustic Neuroma Dx

A

MRI

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13
Q

Acoustic Neuroma tx

A

Surgery or focused radiation therapy

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14
Q

Epidural hematoma etiology

A

Arterial Bleed MC between skull and dura

MC after temporal bone fx: middle meningial artery disruption

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15
Q

Epidural Hematoma Sx

A

Brief LOC, lucid interval, coma, HA, n/v, focal neuro sx, rhinorrhea d/t CSF fluid

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16
Q

Epidural hematoma dx

A

CT: Lemon bleed

Does NOT cross suture lines

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17
Q

Epidural hematoma tx

A

Herniate if not evacuated early; obs if small

If increased ICP: Mannitol, hyperventilation, head elevation (HOB 30 degrees), potentially a shunt

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18
Q

Subdural Hematoma etiology

A

Location: MC venous bleed, between dura and arachnoid d/t tearing of cortical bridging veins, MC in elderly

Mechanism: MC blunt trauma often causes bleeding on other side of injury

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19
Q

Subdural Hematoma sx

A

May have foval neuro sx

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20
Q

Subdural Hematoma dx

A

CT: concave, banana shape bleed

CAN CROSS SUTURES

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21
Q

Subdural Hematoma Management

A

Evacuation vs. supportive

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22
Q

Subarachnoid Hemorrhage etiology

A

Location: arterial bleed a/w arachnoid and pia
Mechanism: MC berry aneurysm rupture

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23
Q

Subarachnoid Hemorrhage Sx

A

Thunderclap headache: U/L, occipital area, meningeal symptoms: stiff neck, photophobia, AMS, no focal neuro deficits

Terson Hemorrhage: retinal hemorrhage

24
Q

Subarachnoid Hemorrhage Dx

A

CT scan W/O contrast first
If negative: LP

4 vessel angiography after confirmed SAH

25
Q

SAH Tx

A

Supportive: bed rest, stool softeners, lower ICP, surgical coiling
Lower BP gradually

26
Q

Incracerebral Hemorrhage Etiology/dx/tx

A

Location: intraparenchymal
Mechanism: HTN, AVM, Trauma

Dx: CT scan, NO LP

Tx: decrease BP gradually IV mannitol

27
Q

Cluster Headache sx

A

severe u/l periorbital/temporal pain, pouts lasting less than 2 hours with spontaneous remission

Triggers: worse at night, ETOH, stress

28
Q

Cluster headache PE/tx

A

Ipsilateral horners syndrome: ptosis, miosis, anhidrosis

Tx: 100% O2 1st line, antimigraine meds Sumatriptan

PPX: verapamil 1st line

29
Q

Complex Regional Pain Syndrome (CRPS) etiology

A

Formerly known as reflex sympathetic dystrophy

30
Q

CRPS sx

A

MC: upper extremities
Stage I: pain out of proportion to injury
Stage II: waxy/pale skin, brittle nails, loss of hair
Stage III: joint atrophy, contractures

31
Q

CPRS Tx

A

NSAIDS initial treatment

Vit C ppx after fx

32
Q

GCS

A

Eye opening
Verbal response
Motor Response

Best: 15
Comatose <8
Unresponsive: 3

33
Q

Concussion etiology

A

mild traumatic injury, alteration in mental status with or without LOC

34
Q

Concussion sx

A

Confusion: confused or blank expression
Amnesia
HAs, dizziness
Signs of increased intracranial pressure: vomiting, increasing disorientation

35
Q

Concussions Dx

A

CT scan: study of choice

MRI: study of choice IF prolonged sx >7-14 days

36
Q

Concussion Tx

A

Cognitive and physical rest

37
Q

Delirium

A

acute, abrupt, transient confused state d/t an identifiable cause (meds, hospital stay, infections.

Usually full recovery in 1 week

38
Q

Dementia

A

Progressive, chronic intillectual deterioration of selective functions; memory loss and loss of impulse control, motor/cog fxns

Risk: >60 years old, vascular disease

39
Q

Alzheimer’s Disease

A

MC type of dementia, amyloid deposits

Dx: CT scan shows cerebral cortex atrophy

Tx: Ach-esterase inhibitors: Donepezil
NMDA Antagonist: memantine

40
Q

Vascular dementia

A

2nd MC type, chronic ischemic and multiple infarctions

HTN most important risk

41
Q

Fronttemporal dementia

A

Localized brain degeneration of the FT lobes

MARKED PERSONALITY CHANGES

42
Q

Lewy Body Disease

A

Abnl neuronal protein deposits

VISUAL HALLUCINATIONS, delusions, episodic delirium, dementia occurs later in disease

43
Q

Viral (aseptic) meningitis

A

MC: enterovirus, then mumps/HSV

HA, fever, mild confusion, nuchal rigidity, photophobia

44
Q

Viral meningitis dx

A

CSF analysis: MOST IMPORTANT TO DIFFERENTIATE

CT scan done 1st to rule out intracranial mass

45
Q

Viral meningitis tx

A

supportive, antipyretics, IVF

usually self limited

46
Q

Encephalitis etiology

A

MC cause: HSV-1 enterovirus

Infection of parenchyma

47
Q

Encephalitis sx

A

HA, fever, lethargy, AMS, Abnl cerebral fxn

48
Q

Encephalitis Dx

A

CSF analysis: lymphocytosis, normal glucose, increased protein

49
Q

Encephalitis Tx

A

Supportive care, control edema, antipyretics, seizure ppx

Valcyclovit if HSV
Higher morbidity than viral meningitis

50
Q

Acute bacterial meningitis

etiology/sx

A

hx of sinusitis or pneumonia prior to meningitis

sx: fevers, chills, meningeal sx

51
Q

Acute bacterial meningitis dx

A

LP: neutrophils, decreased glucose, increased total protein, increased CSF pressure

CT: r/o mass before LP

52
Q

Bacterial meningitis <1 month old

A

Organism: GBS
Tx: Ampicillin + cefotaxime

53
Q

Bacterial meningitis 1m -18y

A

Organism: N meningitis
Tx: Ceftriaxone + Vanc

54
Q

Bacterial Meningitis 18y-50y

A

Organism: S. Pneumo and N. Meningitis
Tx: Ceftriaxone + Vanc

55
Q

Bacterial Meningitis >50yo

A

Organism: S. pneumo, listeria monocytogenes
Tx: Ampicillin, Ceftriaxone, and Vanc

Internal Medicine EOR (8 decks)

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