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Internal Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q 
Bell Palsy
Path:
Pt:
Ramsay-Hunt syndrome, Bell phenomenon
Dx:
Tx:
A

Path: Idiopathic; unilateral CN VII facial nerve palsy due to inflammation or compression (lower motor neuro lesion)
Strong associated with w/ HSV

Pt:
Ipsilateral facial weakness w/ forehead involvement, drooling, loss of taste, tongue numbness, ear/retro-auricular pain

Preserved ability to raise eyebrows suggests central process (forehead innervated bilaterally)

Ramsay-Hunt syndrome: Bell’s palsy + facial varicella zoster infection
Bell phenomenon: eye on affected side moves laterally & superiorly when eye closure is attempted
No other focal neurological deficits

Dx: DOE

Tx:
Self-limiting 1 months
Prednisone: start within first 72 hrs of onset for max benefit
Artificial tears- replace lacrimation, reduce vision problems +/- eye patch/taping eye shut to sleep if severe
Acyclovir: severe cases have been shown to improve symptoms/limiting of recovery

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2
Q 
Cerebral Aneurysm 
Path:
Pt:
Dx:
Tx:
Complication:
A

Path: Weakness in blood vessel in brain that balloons and fills w/ blood

Pt: Asx
HA, N/V, bleeding, dizziness, light sensitivity, stiff neck, thunderclap HA

Dx: MRI, MRA, CT, CTA

Tx:
Supportive 
Embolization, endovascular coiling/clipping
Antihypertensives, anticoagulants 
Endovascular aneurysm repair

Complications: Subarachnoid hemorrhage

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3
Q 
Ischemic cerebral vascular accident 
Path:
Pt:
Dx:
Tx:
A

Path: thrombosis, embolism, hypoperfusion
risks: smoking, old age, male, DM, HTN, hyperlipidemia

Pt:
Anterior:
MCA (MC): contralateral sensory/motor loss: face (eyebrows normal), and arm
ACA: contralateral sensory/motor loss: leg and foot
Posterior
PCA: visual hallucinations, contralateral homonymous hemianopsia; ipsilateral CN deficits and contralateral muscle weakness
Basilar: cerebellar dysfunction-> CN palsies, dec vision, dec bilateral sensory
Vertebral: vertigo, nystagmus, N/V, diplopia, ipsilateral ataxia

Dx: Non-con CT- loss of grey-white interface, acute hypo density (maybe normal for 1st 6-24hrs)

Tx: Thrombolytics (rTPA, alteplase)- within 3hrs of onset (some cases 4.5hrs) if no evidence of hemorrhage

Antiplatelets: ASA, clopidogrel, dipyridamole
ASA- acute setting if after 3 hrs and thrombolytics aren’t given or >/= 24 hours after thrombolytics

+/- anticoagulation- if cardio-embolic

Indications to manage HTN:
Thrombolytics > 185/110
No thrombolytics if >220/120 or MAP >/= 130

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4
Q 
Cluster headaches
Path:
Pt:
Dx:
Tx:
A

Path:
Not fully understood
M > F

Pt:
Serve unilateral periorbital/temporal HA lasting <2 hrs w/ spontaneous remission
Sharp suicide HA
Attacks recur 4-8w, 1-8/day at the same time each day

Associated autonomic features (1 confirms dx)
Ipsilateral Horner’s: ptosis, anhidrosis
Rhinorrhea
Conjunctival injection
Lacrimation
Aural fullness

Dx: Clx
MRI/CT- presentation consistent w/ secondary HA-> Carotid dissection, aneurism, AVMs, tumors, giant cell arthritis

Tx:
Acute- oxygen, triptans, external vagus nerve stimulation, intranasal lidocaine
Transitional (terminate daily attacks while preventive therapy is started)-> corticosteroids, prednisone taper

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5
Q

Glasgow coma scale (GCS)

A 
Eye opening
'Spontaneous- 4
'Response to verbal commands- 3
'Response to pain- 2
'No eye opening- 1
Best verbal response 
'Oriented- 5
'Confused- 4
'Inappropriate words- 3
'Unintelligible sounds- 2
'No verbal response- 1
Best motor response 
'Obeys commands- 6
'Localizing response to pain- 5
'Withdrawal response to pain- 4
'Flexion to pain- 3
'Extension to pain- 2
'No motor response- 1

Mild brain injury >/=13
Moderate 9-12
Severe = 8

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6
Q 
Myasthenia-Gravis 
Path:
Pt:
Dx:
Tx:
A

Path: antibodies to acetylcholine receptors at the neuromuscular junction

Pt: ptosis, diplopia, dysphagia, dysarthria, and proximal muscle weakness

Dx:
+ tensilon test
+acetylcholine receptor binding abs
CT chest-> thymic mass

Tx: Pyridostigmine, neostigmine
steroids >60, thymectomy <60
Crisis: Plasmapheresis, IVIG

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7
Q 
Guillain-Barre
Path:
Pt:
Dx:
Tx:
A

Path: Autoimmune peripheral demyelinating

Pt: Ascending paralysis following diarrhea or vaccination

Dx: intubation (if needed)
LP-> lots of protein, few cells
Best-> nerve conduction test

Tx: IVIG = plasmapheresis
NEVER give steroids!!!!

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8
Q 
Multiple-Sclerosis
Path:
Pt:
Dx:
Tx:
A

Path: autoimmune central NS demyelinating

Pt: neuro sxs separated in both time and space
optic neuritis=blurry vision

Dx: MRI-> periventricular white lesions, demyelinated plaques

Tx:
acute: methylprednisolone x5 days
Chronic: interferon + glatiramer

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9
Q 
Grand Mal Seizure
Path:
Pt:
Dx:
Tx:
A

Path: generalized, complex

Pt:
Convulsions = tonic clonic jerking
Loss of consciousness

Dx: EEG

Tx:Benzodiazepines

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10
Q 
Myoclonic Seizure
Path:
Pt:
Dx:
Tx:
A

Path: simple, partial

Pt:
Spastic contractions
NO loss of consciousness

Dx: EEG

Tx: Valproate

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11
Q 
Absence Seizure
Path:
Pt:
Dx:
Tx:
A

Path: partial, complex

Pt:
Maintains tone
Loses consciousness- 100s of times per day
Children, you think they are ADD

Dx: EEG

Tx:
Ethosuximide
Valproate

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12
Q 
Atonic Seizure
Path:
Pt:
Dx:
Tx:
A

Path: Partial, simple

Pt:
Loses tone
Maintains consciousness

Dx: EEG

Tx: Valproate, helmets

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13
Q

Tension Headache
Path:
Pt:
Tx:

A

Path: Mental stress

Pt:
Bilateral, tight, band-like
No N/V or focal neurologic symptoms

Tx:
NSAIDs, aspirin, Tylenol
TCAs in severe recurrent cases
PPX: beta blockers

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14
Q

Cluster Headache
Pt:
Dx:
Tx:

A

Pt: Serve unilateral periorbital/temporal HA lasting <2 hrs w/ spontaneous remission
Sharp suicide HA
Attacks recur 4-8w, 1-8/day at the same time each day
Associated autonomic features (1 confirms dx)
Ipsilateral Horner’s: ptosis, anhidrosis
Rhinorrhea
Conjunctival injection
Lacrimation
Aural fullness

Dx:
Clx
MRI/CT- presentation consistent w/ secondary HA
Carotid dissection, aneurism, AVMs, tumors, giant cell arthritis

Tx:
Acute- oxygen, triptans, external vagus nerve stimulation, intranasal lidocaine

Transitional (terminate daily attacks while preventive therapy is started)-> corticosteroids, prednisone taper

ppx: verapamil, lithium, valproate

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15
Q

Migraines
Pt:
Tx:

A

Pt: pulsing, unilateral, nausea, disabling, aggravated by physical activity, typically associated w/ photophobia

Tx: triptans
ppx: MgO, B2, coenzyme Q10, TCA/SSRI

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16
Q 
Giant Cell Arteritis 
Path:
Pt:
Dx:
Tx:
A

Path: Systemic arteritis of medium sized arteries, incidence increases w/ age >60 yrs

Pt: variable
Non-specific HA +/- tender, thrombosed temporal artery, jaw claudication, scalp tenderness, scalp necrosis, tongue ischemia
Associated w/ Polymyalgia rheumatica
sx: fatigue, malaise, weight loss, depression, myalgia, arthralgias
Visual sx: amaurosis fugax (transient vision loss), diplopia, may cause rapid and permanent blindness

Dx:
Temporal artery bx
ESR, CBC w/ plt count (anemia, thrombocytosis), CRP

Tx:
Prednisone & tocilzumab (emergent to prevent blindness)

17
Q 
Meningitis
Path:
Pt:
Dx:
Tx:
Other paths and txs
A

Path:
<1m: S. Agalactiae, E. Coli, listeria, klebsiella
1-23m: S. agalactiae, e coli, s. Pneumonia, nisseria meningitidis, h. Influenzae
2-50yrs: s. Pneumoniae, nisseria meningitis
>50yrs: s. pneumoniae, nisseria meningitids, listeria, aerobic gram-negative bacilli

Pt: fever, HA, stiff neck

Dx: LP-> many neutrophils

Tx: ceftriaxone, vancomycin, steroids
immunocomp: ampicillin

Syphilis: VDRL, RPR in CSF-> IV PCN
Lyme: lyme ab in CSF-> ceftriaxone
Cryptococcus-> cryptococcus antigen -> amphotericin
RMSF: RMSF ab-> ceftriaxone

18
Q

Meningitis LP or abx?

A 
FAILS
focal neuro deficit
AMS
immunocompromised
lesions over the site of LP
seizures

IF FAILS…. ABX first, then CT, then LP
If NOT fails… LP first, then abx

19
Q 
Encephalitis
Path:
Pt:
Dx:
Tx:
A

Path: viral

Pt: fever, HA, AMS

Dx: CT scan w/ antibodies
Best-> LP: lymphocytes.. get HSV PCR

Tx: herpes w/ acyclovir

flaccid paralysis: west nile
temporal lobe: herpes encephalities

Internal Medicine (10 decks)

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