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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
Q

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

A

Cluster HA

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26
Q

Prophylaxis of Cluster HA

A

Verapamil (CCB)

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27
Q

Pseudotumor Cerebri

A

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)

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28
Q

High IgG (oligoclonal bands) on CSF

A

Multiple Sclerosis

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29
Q

Guillain Barre syndrome

A

High protein w normal WBC count on CSF

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30
Q

Fungal or TB meningitis will show what on CSF

A

Decreased glucose

increased WBC

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31
Q

Xanthochromia in CSF

A

Subarachnoid hemorrhage!!! SAH

“worse headache of life”

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32
Q

Loss of Dopamine neurons in the Substantia Nigra

A

Parkinsons Dz

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33
Q

Pathophys of Parkinsn

A

Loss of DA means can’t inhibit Ach

Also inhibit’s DA’s ability to start movement

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34
Q

Triad of Parkinsons

A

Resting tremor
Bradykinesia (slow movement)
Muscle rigidity

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35
Q

First finding of Parkinson

A

Resting tremor, “pill rolling”

worse at rest and with emotional stress
starts out on one side

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36
Q

Face involvement of Parkinson’s

A

Fixed stare

“Myerson’s sign” tapping bridge of nose over and over = sustained blink

37
Q

When does Dementia start with Parkinsons?

A

it is a late finding

38
Q

Lewy bodies in the Substantia Nigra

A

Parkinson’s dz

39
Q

Most effective tx for Parkinson’s dz

A

Levodopa-carbidopa

40
Q

What may be used as initial tx for Parkinsons?

A

DA agonist- Bromocriptine, Pramipexole, Ropinirole

41
Q

Why is Carbidopa added to Levodopa?

A

C reduces the amt of L needed, and also reduces the SE of L

42
Q

Downfall of Levodopa

A

it wears off after a while

43
Q

Who should DA agonist be considered in

A

Younger pts to delay the use of Levodopa

those <65 YO

44
Q

Younger pt <70 has tremor as predominant sx, what is the best tx?

A

Anticholinergic

  • Trihexyphenidyl
  • Benztropine
45
Q

Neurodegenerative disorder of Upper AND Lower motor neurons

Idiopathic

A

ALS
Amyotrophic Lateral Sclerosis
“Lou Gehrig’s Dz”

46
Q

What is spared with ALS?

A

Sensation, voluntary eye mov, sphincter fx, sexual fx

47
Q

Clinical sx of ALS

A

Asymmetric limb weakness
Difficulty chewing, aspiration
Cognitive impairment-frontotemporal

48
Q

Mixed upper and lower motor neuron sx = hallmark

A

Spastic, stiff, weak

Progressive bilateral fasciculations, muscle Atrophy, hyporeflexia

49
Q

Only drug known to reduce progression of ALS for up to 6 months

A

Riluzole

will need to consider respiratory aid as dz progresses- CPAP, BiPAP, Ventilator

50
Q

Cerebral Palsy dx

A

Primarily clinical but MRI is REQUIRED in all pts

51
Q

Tx for Cerebral Palsy

A

Spasticity: Baclofen, Diazepam
Seizures: Anti-epileptic

52
Q

Examples of DA agonist

A

Pramipexole

Ropinirole

53
Q

What can cause Restless leg syndrome?

A

CNS Iron deficiency

Check Iron levels

54
Q

Tx for Restless leg syndrome

A

DA agonist

  • Pramipexole
  • Ropinirole
55
Q

Sudden onset of ipsilateral ear pain –> 24-48 hours later Unilateral facial weakness/paralysis involving the forehead

Unable to lift affected eyebrow

A

Bells Palsy

CN7

56
Q

Bell phenomenom

A

Eye on the affected side moves laterally and superiorly when eye closure is attempted

57
Q

Other sx of Bell’s Palsy

A

drooping corner of mouth
taste disturbance- anterior 2/3
unable to fully close eye

58
Q

What causes Bells Palsy

A

possibly related to Herpes Virus Reactivation

Compression/inflammation of CN7

59
Q

Tx of Bells Palsy

A

mostly Supportive- will prob resolve w/in 1 month
Artifical tears

PREDNISONE within 72 hr sx onset may speed recovery

60
Q

Severe cases of Bells Palsy can be treated w

A

Acyclovir + Prednisone

61
Q

Starts at Toes, extends upppp the body
peripheral neuropathy

After GI or Respiratory infection (C.Jejuni)

A

Guillain Barre syndrome

62
Q

PE of Guillan Barre pt

A

Decreased DTR
Flaccid paralysis, weakness
Sensory def
Autonomic- tachycardia, arrhythmia, hypotension, breathing difficulty

63
Q

Dx of Guillan Barre

A

Nerve conduction study

CSF: high protein

64
Q

Tx for Guillian Barre

A

Plasmapharesis or IVIG

65
Q

Prognosis for Guillian Barre

A

60% will have full recovery in 1 year

66
Q

Problem with Ach receptors
Muscle fatigue with repeated exertion
Young women

A

Myasthenia Gravis

67
Q

Myasthenia Gravis

A

Autoimmune attack of Ach receptors

Eye weakness, generalized weakness
1st sx: Diplopia and Ptosis

68
Q

Myasthenia Crisis includes

A

weakness of the Respiratory muscles–> resp failure

69
Q

Dx Myasthenia Gravis in outpatient setting

A

Ach receptor antibodies
MuSK antibodies
Most accurate: Repetitive nerve stimulation or Electromyography

70
Q

EMG and Repetitive nerve stimulation

A

most accurate for dx of Myasthenia Gravis

71
Q

What do you need to consider with Myasthenia Gravis?

A

Chest imaging- THYMUS gland

72
Q

Dx Myasthenia Gravis in Emergent Setting

A

Edrophonium/Tensilon test- brief imp after administration

Ice pack test

73
Q

Tx for Myasthenia CRISIS

A

IVIG or Plasmapharesis

74
Q

Long term tx for Myasthenia Gravis

A

ACHe-I
-Pyridostigmine
-Neostigmine
and THYMECTOMY

75
Q

Pyridostigmine

Neostigmine

A

1st line tx for Myasthenia Gravis

76
Q

Edrophonium

A

used for testing /diagnosing Myasthenia Gravis

77
Q

Young women
Weakness gets worse w repeated exertion

Eye and respiratory can be affected

A

Myasthenia Gravis

Ach receptors are being attacked

Tx: Neostigmine, Pyridogstigmine

78
Q

MS- Multiple Sclerosis

A

Inflammatory, Auto-immune, demyelinating of the WHITE MATTER- brain and spinal cord

79
Q

MS

A

Sensory disturbance –> Visual problems and Weakness

80
Q

Uhthoff’s phenomenon

A

Sx are worse with heat

81
Q

Does MS have Upper motor or Lower motor neuron signs?

A

Upper motor neuron- spasticity, upward Babinski, hyperreflexive

82
Q

Lhermitte sign associated with Multiple Sclerosis

A

lightning pain from spine down the leg

83
Q

Spinal cord sx of Multiple Sclerosis

A

bladder, bowel, or sexual dysfx

84
Q

Dx of Multiple Sclerosis

A

MRI w gadolinium- hyperintense white matter plaques

85
Q

Lumbar Puncture in someone with Multiple Sclerosis may show

A

IgG and Oligoclonal bands

reflect inflammatory cells penetrating the BBB

86
Q

Tx of Multiple Sclerosis

A

High dose IV Glucocorticoids for Acute exacerbation

87
Q

Tx of Multiple Sclerosis (prevent relapse/ progression)

A

Beta-interferon or

Glatiramer

88
Q

What is helpful for spasticity sx?

A

Diazepam

Baclofen

89
Q

What types of Multiple Sclerosis exist?

A

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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