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Neurology Flashcards

1
Q

GCS is based on

A

Eye response
Verbal response
Motor response

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2
Q

Max score for eye portion

A

4 points

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3
Q

Max score for verbal portion

A

5 points

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4
Q

Max score for motor portion

A

6 points

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5
Q

Mild TBI is a GCS score of

A

13 or higher

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6
Q

Moderate TBI is a GCS score of

A

9-12

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7
Q

Severe TBI is a GCS score of

A

8 or below

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8
Q

Cushing’s triad assoc w/ TBI

A

HTN
Bradycardia
irregular respiration

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9
Q

Tx of TBI: first, send to ICU

A

Prevent hypoxia
Surgically evaluation hematoma
Reduce intracranial pressure

Avoid fever and hyperglycemia

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10
Q

Signs of increased ICP

A

persistent vomiting
worsening HA
disorientation
changing LOC

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11
Q

study of choice for evaluating most ACUTE head injuries

A

CT without contrast

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12
Q

Lower motor neuron sx

A 
Muscles are FLABBY
Fasiculations
Flaccid paralysis
Loss of msucle tone
Areflexia (decreased DTR)
Babinski twds basement- toes down
Young (infantile)
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13
Q

Conditions associated with LOWER motor neuron damage

B’s

A 
Guillian Barre 
Botulism
Poliomyeltis (baby)
Cauda equina syndrome (back)
Bells palsy
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14
Q

Upper motor neuron sx

A 
SPASTIC
Slight muscle tone
Positive babinski- toes fan up
Absence of fasciulations
Strone tone
Tone increased
Increased DTR
Clonus
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15
Q

Conditions associated with UPPER motor neuron damage

S’s

A

Stroke
Multiple Sclerosis
Cerebral PalSy
Spinal cord or brain damage

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16
Q

CN4

A

Trochlear

Superior oblique rectus

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17
Q

CN6

A

Abducens

Lateral rectus

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18
Q

Conditions assoc w/ abnormalities of CN7

A

Facial nerve

  • Bells plasy
  • CN 7 palsy
  • Ramsay Hunt syndrome
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19
Q

Conditions assoc w/ abnormalities of CN5

A

Trigeminal Neuralgia

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20
Q

How to test CN2 (optic)

A

Visual acuity
Visual fields
Pupillary light reflex

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21
Q

Trigeminal Neuralgia

CN 5 being compressed

A

Middle aged woman
Stabbing, shock like pain
Start near mouth and –> eye, ear, nostril

Tx: Carbamazepine

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22
Q

Can you give Triptans to pregnant ladies to get rid of Migraine?

A

Try to avoid, but Ergots on the other hand are ABSOLUTELY CONTRAINDICATED in pregnancy

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23
Q

Triptans
Ergots

in pregnancy

A

Triptans: avoid
Ergots: NO NO

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24
Q

Prophylaxis of Migraines

A

B-blockers- Propranolol

CCB- Verapamil

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25
Periorbital HA, sharp, lancinating lasting <2 hours, may occur several x/day Horner's synd- ptosis, miosis, anhidrosis Nasal congestion, rhinorrhea, lacrimation tx: 100% oxygen
Cluster HA
26
Prophylaxis of Cluster HA
Verapamil (CCB)
27
Pseudotumor Cerebri
Intracranial HTN with no identifiable cause (idiopathic) Cause: obese women, steroid withdrawal, thyroid replacement meds, birth control, Tetracyclien use, Vit A toxicity Sx: HA, n/v, visual changes PE: Papilledema Tx: Acetazolamide (diuretic)
28
High IgG (oligoclonal bands) on CSF
Multiple Sclerosis
29
Guillain Barre syndrome
High protein w normal WBC count on CSF
30
Fungal or TB meningitis will show what on CSF
Decreased glucose | increased WBC
31
Xanthochromia in CSF
Subarachnoid hemorrhage!!! SAH "worse headache of life"
32
Loss of Dopamine neurons in the Substantia Nigra
Parkinsons Dz
33
Pathophys of Parkinsn
Loss of DA means can't inhibit Ach | Also inhibit's DA's ability to start movement
34
Triad of Parkinsons
Resting tremor Bradykinesia (slow movement) Muscle rigidity
35
First finding of Parkinson
Resting tremor, "pill rolling" worse at rest and with emotional stress starts out on one side
36
Face involvement of Parkinson's
Fixed stare | "Myerson's sign" tapping bridge of nose over and over = sustained blink
37
When does Dementia start with Parkinsons?
it is a late finding
38
Lewy bodies in the Substantia Nigra
Parkinson's dz
39
Most effective tx for Parkinson's dz
Levodopa-carbidopa
40
What may be used as initial tx for Parkinsons?
DA agonist- Bromocriptine, Pramipexole, Ropinirole
41
Why is Carbidopa added to Levodopa?
C reduces the amt of L needed, and also reduces the SE of L
42
Downfall of Levodopa
it wears off after a while
43
Who should DA agonist be considered in
Younger pts to delay the use of Levodopa | those <65 YO
44
Younger pt <70 has tremor as predominant sx, what is the best tx?
Anticholinergic - Trihexyphenidyl - Benztropine
45
Neurodegenerative disorder of Upper AND Lower motor neurons Idiopathic
ALS Amyotrophic Lateral Sclerosis "Lou Gehrig's Dz"
46
What is spared with ALS?
Sensation, voluntary eye mov, sphincter fx, sexual fx
47
Clinical sx of ALS
Asymmetric limb weakness Difficulty chewing, aspiration Cognitive impairment-frontotemporal
48
Mixed upper and lower motor neuron sx = hallmark
Spastic, stiff, weak | Progressive bilateral fasciculations, muscle Atrophy, hyporeflexia
49
Only drug known to reduce progression of ALS for up to 6 months
Riluzole will need to consider respiratory aid as dz progresses- CPAP, BiPAP, Ventilator
50
Cerebral Palsy dx
Primarily clinical but MRI is REQUIRED in all pts
51
Tx for Cerebral Palsy
Spasticity: Baclofen, Diazepam Seizures: Anti-epileptic
52
Examples of DA agonist
Pramipexole | Ropinirole
53
What can cause Restless leg syndrome?
CNS Iron deficiency | Check Iron levels
54
Tx for Restless leg syndrome
DA agonist - Pramipexole - Ropinirole
55
Sudden onset of ipsilateral ear pain --> 24-48 hours later Unilateral facial weakness/paralysis involving the forehead Unable to lift affected eyebrow
Bells Palsy CN7
56
Bell phenomenom
Eye on the affected side moves laterally and superiorly when eye closure is attempted
57
Other sx of Bell's Palsy
drooping corner of mouth taste disturbance- anterior 2/3 unable to fully close eye
58
What causes Bells Palsy
possibly related to Herpes Virus Reactivation | Compression/inflammation of CN7
59
Tx of Bells Palsy
mostly Supportive- will prob resolve w/in 1 month Artifical tears PREDNISONE within 72 hr sx onset may speed recovery
60
Severe cases of Bells Palsy can be treated w
Acyclovir + Prednisone
61
Starts at Toes, extends upppp the body peripheral neuropathy After GI or Respiratory infection (C.Jejuni)
Guillain Barre syndrome
62
PE of Guillan Barre pt
Decreased DTR Flaccid paralysis, weakness Sensory def Autonomic- tachycardia, arrhythmia, hypotension, breathing difficulty
63
Dx of Guillan Barre
Nerve conduction study | CSF: high protein
64
Tx for Guillian Barre
Plasmapharesis or IVIG
65
Prognosis for Guillian Barre
60% will have full recovery in 1 year
66
Problem with Ach receptors Muscle fatigue with repeated exertion Young women
Myasthenia Gravis
67
Myasthenia Gravis
Autoimmune attack of Ach receptors Eye weakness, generalized weakness 1st sx: Diplopia and Ptosis
68
Myasthenia Crisis includes
weakness of the Respiratory muscles--> resp failure
69
Dx Myasthenia Gravis in outpatient setting
Ach receptor antibodies MuSK antibodies Most accurate: Repetitive nerve stimulation or Electromyography
70
EMG and Repetitive nerve stimulation
most accurate for dx of Myasthenia Gravis
71
What do you need to consider with Myasthenia Gravis?
Chest imaging- THYMUS gland
72
Dx Myasthenia Gravis in Emergent Setting
Edrophonium/Tensilon test- brief imp after administration | Ice pack test
73
Tx for Myasthenia CRISIS
IVIG or Plasmapharesis
74
Long term tx for Myasthenia Gravis
ACHe-I -Pyridostigmine -Neostigmine and THYMECTOMY
75
Pyridostigmine | Neostigmine
1st line tx for Myasthenia Gravis
76
Edrophonium
used for testing /diagnosing Myasthenia Gravis
77
Young women Weakness gets worse w repeated exertion Eye and respiratory can be affected
Myasthenia Gravis Ach receptors are being attacked Tx: Neostigmine, Pyridogstigmine
78
MS- Multiple Sclerosis
Inflammatory, Auto-immune, demyelinating of the WHITE MATTER- brain and spinal cord
79
MS
Sensory disturbance --> Visual problems and Weakness
80
Uhthoff's phenomenon
Sx are worse with heat
81
Does MS have Upper motor or Lower motor neuron signs?
Upper motor neuron- spasticity, upward Babinski, hyperreflexive
82
Lhermitte sign associated with Multiple Sclerosis
lightning pain from spine down the leg
83
Spinal cord sx of Multiple Sclerosis
bladder, bowel, or sexual dysfx
84
Dx of Multiple Sclerosis
MRI w gadolinium- hyperintense white matter plaques
85
Lumbar Puncture in someone with Multiple Sclerosis may show
IgG and Oligoclonal bands reflect inflammatory cells penetrating the BBB
86
Tx of Multiple Sclerosis
High dose IV Glucocorticoids for Acute exacerbation
87
Tx of Multiple Sclerosis (prevent relapse/ progression)
Beta-interferon or | Glatiramer
88
What is helpful for spasticity sx?
Diazepam | Baclofen
89
What types of Multiple Sclerosis exist?
Relapsing remitting- most common Secondary progressive- above type that becomes progressive Progressive- progressive decline w/o exacerbation

Clinical Prep (41 decks)

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