Other Stuff Final

Question 1

There are primary and secondary headaches

Primary are benign headache disorders, whereas secondary headaches are a sign of organic disease

In order to determine which type of headache the patient has, you need a good general history

Worrisome signs that indicate a secondary headache of pathological origin would be

1) WORST HA of all time
2) Onset after ____
3) Atypical HA for patient
4) HA with fever
5) Abrupt onset (Max pain instantly)
6) Subacute HA with progressive worsening over time
7) Drowsiness, confusion, memory impairment
8) Weakness, ataxia, loss of coordination
9) Paresthesia/Sensory loss/Paralysis
10) Abnormal medial or neuro exam

Answer 1

2) 50

Question 2

If a patient comes in with a horrible headache, first time they’ve ever had it, and you order blood work (CBCs) and a CT scan and it all comes out normal… Your next move would be to order a ____ because CT scans can miss 5-10% of _____s

Answer 2

L.P (Lumbar Puncture), subarachnoid hemorrhages

Question 3

____ migraine is a migraine WITHOUT aura

Common migraine is ____ in intensity and it usually inhibits or prohibits a patients daily activity with age of onset around ____ and a female to male ratio of 3:1

The typical description of a common headache is ___/___/____ and they often retreat to a dark/quite room

^** Nausea and vomiting are the most common symptoms, along with photophobia and phonophobia

Answer 3

Common

Moderate to severe, 35-40

Throbbing/sharp/pressure

Question 4

____ migraine is a migraine WITH aura (with the most common aura being visual)

Many patients with episodic migraine (common or classic) will develop ____ migraine where they get it more than 15 days per month* lasting 4 hours or more for a period of at least 3 months

^** Most commonly caused by neurogenic inflammation which is the Trigeminal nerve that becomes activated which releases neuropeptides causing painful neurogenic inflammation within the meninges with subsequent effects on the dural vasculature

Answer 4

Classic

Chronic

Question 5

Tension-type headaches are ____ in intensity and can inhibit, but does NOT ____ daily activities (which remember, common and classic migraines do)

These are typically bifrontal or bioccipital and ___-like in location with the typical description being ___/___/____ pressure

Also there is NO aura… If a patient has an aura it is 100% classic migraine

Answer 5

Mild to moderate, prohibit

band-like, Dull/aching/squeezing

Question 6

____ headaches are SEVER and EXCRUCIATING in pain and prohibits all activities

MALES are 6 times more likely to get this headache (common and classic, females are more likely)

Often associated with ____

**These headaches occur most commonly as episodic with 1 more more attacks per day, short in duration (30 mintues to 2 hours) and 100% of them are ____ in location and generally orbitotemporal*******

^** Remember, Migraines could be either uni or bi, and Tension-type is most commonly Bi-frontal/Bi-occipital, but clusters are 100% Unilateral

Behavior is frenetic, pacing, and rocking with symptoms including ptosis or miosis (on same side of headache), conjunctival injection, lacrimation, or stuff/runny nose

Alcohol is a common trigger along with weather change or stress

* There is another thing called Paroxysmal Hemicrania, which has almost the exact same presentation as Cluster HAs (unilateral, peri-orbital, sever/excruciating, lacrimation, conjunctival irritation) however, the DURATION is only ____, compared to the 30min-2 hours seen in Cluster HAs and this can be treated via ____**

Answer 6

Cluster

Obstructive sleep apnea

Unilateral

Minutes, Indomethacin

Question 7

Treatment for acute migraine can include OTCs, NSAIDs, Opioids, and ____ which is a 5HT1 agonist (various kinds such as Imitrex)

^** Contraindications for Triptan includes strong risk factors of CV problems, Raynauds syndrome, HT, Renal or liver problems, etc… Also DO NOT take more than 1 5HT1 agonist within a 24 hour period or with ergotamines or MAOIs

If nausea or vomiting is a major feature of migraine you could give an antiemetic like Metoclopramide or prochlorperazine before analgesic mediation

If insomnia is a major feature you could give a sedative/hypnotic like diazepam or temazepam or thorazine

If a patient has one or more headaches per week, now you want to start thinking about preventive treatment of migraine such as antidepressants (TCAs/SSRIs/MAOIs), Beta blockers, etc….

^***** However the only FDA approved treatment for Chornic migraine is ____****

Answer 7

Triptans

BOTOX injection

Question 8

Nonprescription Txs could include stop smoking, exercise, Riboflavin, and the best is Biofeedback/Relaxation/Stress management

For acute Tx of Tension HAs, you could use OTCs, NSAIDS, Opioids, etc

For preventive Tx of Tension HAs, you could use Antidepressants, BOTOX, etc (similar to migraine treatment)

For acute Tx of Cluster HAs, you could use DHE, Lidocaine, or Oxygen at ___% 8L/min via ____

For preventive Tx of Cluster HAs, you could lithium or ____ x 10-14 days

Answer 8

100% 8L/min by mask

Prednisone

Question 9

**_____ is sharp, shooting, electrical quality pain occurring in paroxysm (little bouts of pain), often frequent throughout the day and often treatment can be ____ ********

^**** WILL BE ON THE TEST

Answer 9

Trigeminal Neuralgia

Carbamazepine (or oxcarbamazepine)

Question 10

SUNCT syndrome (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) is a syndrome with excruciating, burning, stabbing, electrical HAs in the peri-orbital area lasting for a few seconds to minutes throughout the day and occurs in ____ (men or females?) over 50 with the treatment being anticonvulsants, specifically, ____

Answer 10

Men, Lamotrigine

Question 11

Strokes are generally either Hemorrhagic (20%) or Ischemic (80%)

To prevent a stroke, you want to prevent medical complications since those account for 50% of deaths (like pneumonia, DVT, PE, UTI, or decubitus ulcers)

********Acute HTN is common in acute ____ stroke and in most cases ____ (should or should not?) be treated

Thea area of infract may have lost autoregulation function, so if this patient has “normal” BP, it might be hypotensive in the brain aka this is bad…. So you want to increase BP (HIGH BP) so that the BP in the brain is not to low ****

Answer 11

Ischemic, should NOT

Question 12

All stroke patients need IV access and IV fluids should NOT contain ____ since hyperglycemia causes worst neurological outcomes… Just use regular saline

If you suspect an ischemic stroke (commonly due to a clot) you give a patient tPA (which is a clot buster aka breaks down clots) and ___ IV accesses points must be used

^** Also it is intended to help them, however you also have an increased risk for ____ due to the fact that a patient with an ischemic stroke has their tissues friable and it could cause bleeding

You can use the NIH stroke scale to predict risk of bleeding and a score less then ___ = very low risk (2-3%) and if more than ___ = 17% risk

** So just to recap… High blood sugar (glucose) = bad outcome, and remember lowering blood pressure is also a bad outcome*** Also if the patient had an acute stroke and they have a FEVER = BAD OUTCOME because it is toxic to the brain****** so do anything you can to get the fever down

Answer 12

Glucose

2

10, 20

Hemorrhage

Question 13

There are other things that look like stroke, but are NOT… Such as seizures, migraine, hypoglycemia, etc…

So once again, if a patient has had an ischemic stroke (determined after testing like CT scans, etc…) then you can administer them ____

^** But be careful because if you order a CT scan and you see something then you should be suspicious if it’s really an ischemic stroke because usually they take 72 hours to show up on CT scan… So you need to go back and check with the history or his relatives

** Heparin ____ (is or is not?) used in ischemic strokes anymore

Answer 13

t-PA

Is NOT

Question 14

Normally, you would use Aspirin (ASA) or some other agents like Aggrenox or Palvix to decrease the risk of stroke through its effects as an anticoagulant…

********However, there are certain situations when one would use ____ (or one of the newer drugs like Pradaxa, Xarelto, or Eliquis) instead such as ____, a prosthetic ____, M.I, _____ defects, ____-coagulable states, ____ vessel disease, etc…*******

Answer 14

Warfarin, Atrial Fibrillation, Prosthetic Valve, Atrial septal defects, Hyper-coagulable, Large

Question 15

Exacerbations and remissions, due to the loss of nerve tract insulation (myelin) at multiple sites in the CNS is called ____

^** Presents with tingling (paresthesia), transverse myelitis, weakness, visual loss (optic neuritis), urinary difficulties, dysarthria, etc…

4 types of MS

1) Relapsing-remitting (45-50%)
2) Secondary progressive (20-25%)
3) Primary progressive
4) Benign

* No one single test can determine MS, but some tests include MRI where you might see some ____ lesions of high signal on T2WI in the periventricular white matter and spinal cord, a lumbar puncture which has characteristic features of increased ____ and ____ bands in the CSF*********

^** If the lesion is _____, it will enhance (aka lesions will get MUCH brighter aka contrast enhancing lesions) ******

Answer 15

Multiple Sclerosis

Ovoid, IgG, Oligoclonal bands

Active

Question 16

**Teriflunomide, Glatirimer Acetate, or Interferon Beta are all used for _____ of M.S (aka a disease modifying therapy used to decrease the frequency and severity of exacerbations and slow the progression of the disease)

^***** Be abel to recognize these names*

Betaseron is the only one approved for chronic progressive MS

If a patient comes in with hemiparesis aka an acute exacerbation in MS, you would give them a high dose of ____, like the drug ____ to affect how quickly you get to an outcome (not the outcome itself)

Answer 16

Maintenance

Corticosteroids, Solumedrol

Question 17

It is IMPOSSIBLE to differentiate a first MS attack versus ____ (Acute Disseminated Encephalomyelitis) which is a post-____ or post-____ encephalomyelopathy HOWEVER, you can distinguish them due to the fact that ADEM occurs ONLY ____ time, whereas if the patient develops new lesions then MS is the diagnosis since remember, it is a disease that has multiple lesions over space and time

Other disease that looks like MS are Vitamin B12, Autoimmune disease like Lupus (SLE with cerebritis or CNS vasculitis), Devic’s disease aka NMO (Neuromyelitis Optica) , Lymphoma, Vascular malformations like spinal cord AVM (which presents as 1 lesion)

Answer 17

ADEM, Infectious or immunization, 1

Question 18

Nothing can be used to stop the MS disease, but you can treat it

For spasticity, you can give ____ (via oral or intrathecal) Propranolol for Intention tremor, ___ for urinary retention, Carbamazepine for painful tinging (dysesthesias), and Amantadine for fatigue

Answer 18

Baclofen, Bethanechol

Question 19

Epilepsy is defined as 2 or more unprovoked ____

It is common to use a Single EEG to determine if they are at increased risk for seizures, however like MS, there is no ONE single test to diagnosis the problem

**40% of patients with epilepsy will have a single EEG, however, ____ (with Hyperventilation-HV) there is a 90% chance*****

The percent positive for epilepsy (all types) with ___ sleep-deprived EEGs is 85%

***** Take home is a single EEG does not always tell you about if a patient is having seizures and that petit mal (aka absence) WITH hyperventilation leads to a very high likelihood to pick it up

***** Also although EEGs are important, the ____ of the events is the most important (like witnesses)

Answer 19

Seizure

Petit mal

3

History

Question 20

____ seizure are when the activity begins on one side of the brain and these can be further subdivided into Simple, Complex, or ___ which is when the seizure activity starts on one side of the brain and then spreads to both sides (aka partial onset)

Primary generalized seizures are those that have activity start on both sides of the brain simultaneously

Primary generalized seizures include:

1) Absence seizures, which are the SAME thing as ____ seizures
2) Tonic-clonic
3) Tonic
4) Clonic
5) Atonic
6) Clonic-tonic-clonic

** Tonic is stiffening phase, Clonic is the jerking phase, and Myoclonic is quick jerks

Answer 20

Partial, Secondarily generalized

Petit mal

Question 21

Partial onset seizures include

1) ____ which have focal motor or sensory activity, NO loss of consciousness, last seconds, and NO post-ictal (confused, sleepy, etc…)

^** Aka they go right back to where they were

2) ____ DO have a change in consciousness (unlike simple) in which patients have non-responsive staring, possible preceding aura, automatisms (like picking at clothing), DO HAVE loss of consciousness, 1-3 minutes, and post-ictal
3) Secondary generalized have bilateral tonic-clonic activity, loss of consciousness, 1-3 mins, and post-ictal state

The most common cause of Partial seizures is ____ atrophy

Answer 21

1) Simple
2) Complex

Hippocampal

Question 22

Primary generalized seizures include

1) ____ seizures that have non-responsive staring, rapid blinking, clonic hand motions, LOC, 10-30 seconds, and NO-post-ictal state

^** These are most common in kids so if you have a kid staring off into space and quickly regains consciousness, it is most likely an petit mal seizure**

2) Tonic-clonic where one has bilateral extension (the tonic phase) followed by symmetrical jerking of the extremities (the clonic phase), LOC, 1-3 min, and post-ictal
3) ____ is sudden loss of muscle tone, head drop, patient collapse, LOC, post-ictal
4) ____ is brief, rapid symmetrical jerking, LOC, minimal post-ictal

Answer 22

1) Absence (Petit mal)
3) Atonic
3) Myoclonic

Question 23

If a patient ONLY has absence seizures, the drug of choice is ____

********For partial/secondary generalized seizures know the drugs on the 3rd page of the handout and also the generalized drugs******

^* NOTE Phenobarbital (Valporic acid), Lamotrigine, Topirmate, or Leviteracetam are commonly used for both primary generalized and partial secondary****

Answer 23

Ethosuximide

Question 24

____ 2 drugs are VERY powerful synergistic treatment drugs when you have primary generalized seizures

Answer 24

Valporic acid (Phenobarbital) and Lamotrigine

Question 25

The best drug to treat status epilepticus is ____ and if it doesnt work, midazolam or propofol via IV can be used, and last resort as Pentobarbital

What anti-epileptic drug should you avoid during pregnancy?

Answer 25

Benzodiazepine (or diazepam/lorazepam)

Valproic acid (or phenytoin)

Question 26

Consciousness depends on arousal of the cerebral cortex by the brainstem ____

If you find a patient who is unconscious, they either have

1) Diffuse or b/l impairment of both cerebral hemispheres
2) Failure of brainstem ARAS
3) Both

These are due to 3 different categories of lesions which include

1) Pressure producing supratentorial mass lesion
2) Infratentorial mass lesion (that involves the brainstem)
3) Diffuse or multifocal brain disease (like hepatic failure/coma or anoxic brain damage)

Answer 26

ARAS (Ascending reticular activating system)

Question 27

The Neuro exam to check for stupor and coma includes 6 major things:

1) Pupillary responses

The nuclei/tracts controlling pupils are anatomically adjacent to the ____ so if you have absent or unequal responses, you have a ____ lesion (infratentorial)

Enlarged pupil one one side, think ___ lesion

**Also remember the 3 Ps for PinPoint Pupils…. ____ lesion, ____, and ____ can all cause pinpoint pupils****

Answer 27

ARAS, Brainstem

CN3

Pontine lesion, oPiates, Pilocarpine

Question 28

The Neuro exam to check for stupor and coma includes:

2) Extraocular movements

If the EOMs are dysconjugate aka one eye goes to the right and one to the left, think ___ lesion

If EOMs are conjugate aka move to the same side, the brainstem is INTACT… Now if the eyes move to the same side (aka conjugate) DURING rest, then it is a ____ lesion

^** The most important hemispheric lesions are the ___ gaze centers, which deviate the eyes in the ____ direction so if you lesion the left frontal gaze center in the cerebral hemisphere, you can no longer look to the RIGHT, which means your eyes would both deviate to the ___ during rest (aka TOWARDS the lesion)

^** SO TO RECAP, for DESTRUCtivE HEMISPHERIC LESIONS, you tend to look TOWARDS the lesion

Nystagmus ALWAYS means a ___ lesion and the most common in coma patients is bobbing, which is rapid down and slow up motions, indicating a lesion in the ____

Answer 28

Brainstem

Hemispheric

Frontal, opposite, left

Brainstem, pons

Question 29

For EOMs, the Doll’s eye motion indicates if the ____ is still intact since if it is, then we know CN 3, 4, and 6 are working

^** So if Doll’s eyes present, we know lesion is not in the mid pons and it must be lower… So in order to check that, we can do the _____ reflex to check the _____

^** If lower pons intact, eyes will deviate towards the irrigated ear (one with water)

For example, if you irrigate the left ear and patient looks to the left, and then irrigate the right ear and get no response. The the lesion is on the right, in the LOWER PONS

Answer 29

Mid pons

Caloric (oculovestibular)

LOWER pons

Question 30

The Neuro exam to check for stupor and coma includes:

3) Motor responses

If the arms are flexed, legs extended, it is called ____ posturing and this indicates a lesion to the _____

If ALL extremities are extended, ____ posturing is occurring and indicates a ___ lesion

Answer 30

Decorticate, hemispheric

Decerebrate, brainstem

dEcErEbratE = EEEEtension
^** Has more Es = associated with extension = cerebrate = brainstem

Less Es = Decorticate -> Corticate aka cortex aka hemispheres

Question 31

If a patient is undergoing cheynes-stroke breathing, if most likely means a bilateral ____ lesion, more specifically, the Diencephalon

Answer 31

Hemispheric

Question 32

******Remember, a supratentorial mass lesion can expand leading to ___ syndrome

An ____ transtentorial herniation will compress CN3 causing ____lateral DIALATION, along with ___lateral hemiparesis and respiratory abnormalities, posturing, fixed pupils, and death can occur

A ___ transtentorial herniation occurs when you get herniation into the foramen magnum leading to SMALL pupils, early coma, respiratory arrest, etc….

So UNCAL = ___ pupils and Central = ___ pupils

Answer 32

Herniation

Uncal, Ipsilateral, contralateral

Central

Dilated, small

Question 33

Other than supratentorial mess lesions, subtentorial mass lesions can be noted via brainstem dysfunctions usually dysarthria, dysphagia, diplopia, etc….

Diffuse/metabolic lesions can be identified because they evolve SLOWLY, and ALWAYS*** the ____ reactions are preserved (aka pupils reactive) and one will see ____, myoclonus, tremor, etc

Answer 33

Pupillary, asterixis

Question 34

Brain death is ALWAYS irreversible, persistence, and include all brain function (except for heartbeat)

You would get ALL brainstem reflexes absent and the ___ test would be conducted

Answer 34

Apnea

Question 35

In order to have equilibrium, one must have 2 of the 3 systems intact

Visual, Vestibular (aka Labyrinthine), and Proprioceptive

In oder to tests for these, one can perform the ___ test

This is done by asking patient to close eyes, feet together, and hands out.

If they close eyes, they lose visual input, and if they fall then you know one of the vestibular or proprioceptive pathways is lesioned

**So really, you are testing ______** aka the ___

^** WILL BE ON TEST

Answer 35

Romberg

Proprioception, dorsal columns

Question 36

3 major types of equilibrium disorders

1) ____ is the illusion of movement

^** This is due to a disturbance in the ____ systems (semicircular canals/otoliths)

2) ____ is non-vertigo altered static or dynamic balance
3) ____ is the sense of impending loss of consciousness

Answer 36

1) Vertigo

Vestibular

2) Disequilibrium
3) Presyncope

Question 37

Peripheral vs central (brain and spinal cord)

1) The direction of nystagmus if FIXED in ____ and CHANGEABLE in ____
2) The direction of nystagmus is VERTICAL in ___ and HORIZONTAL/DIAGONAL in ____
3) Isolated vertigo (aka NO other neuro symptoms) in the ___ and ALWAYS other neuro symptoms in ____

Nystagmus is usually indicative of a LABRYNNTHINE problem (vestibular)

Answer 37

1) Peripheral, Central
2) Central, peripheral
3) Peripheral, Central

Question 38

Peripheral causes of vertigo include

1) ____ is characterized by brief recurrent episodes of vertigo triggered by changes in head position with respect to gravity, like when a patient turns over in bed during sleep

^** Thought to be due to debri floating in endolymph of any of the semicircular canals with the most common being the ___ canal**

Confirmed by the ____ testing

2) Vestibular neuronitis last for a while
3) ____ disease often occurs more in females and is thought to be due to an increase in the volume of labyrinthine endolymph because of poor absorption aka endolymphatic hydrops and characteristic ___ frequency hearing loss

^********* So Tinnitus + Vertigo + Low frequency hearing loss = ____

******* WILL BE TESTED ON

4) Drug induced ototoxicity such as _____ (an antibiotic) with one example being _____

^** Or salicylates

Answer 38

1) BPV (Benign positional vertigo)

Posterior

Dix-Hallpike

3) Meniere’s, low

Meniere’s disease

Aminoglycosides, Gentamicin

Question 39

Central causes of vertigo include

1) Vascular like ischemic TIA/stroke or hemorrhage (cerebellar) of ____ malformations and these are all ABRUPT onset
2) Cerebellopontine angle tumors like ___, which generally have their 1st symptom as ____ and the 1st sign as absence of ____
3) ____, which is commonly associated with cancer like lung cancer due to the body producing ABs to the tumor Ags that cross react with cerebellar Purkinje cells
4) Vestibular migraines, which are unaccounted for by other diagnosis
5) Vitamin B12, B1, and E
6) Wilson’s disease
7) Toxins like ethanol

^** Chronic alcohol can affect the cerebellar ____ causing ataxia

Answer 39

1) Chiari
2) Acoustic neuromas (Schwannoma)

Hearing loss, corneal reflex

3) Paraneoplastic cerebellar degeneration (PCD)
7) Vermis

Question 40

For the different types of ataxia

1) _____ ataxia is a slowly progressive cerebellar ataxia of the limbs combined with brainstem signs and peripheral neuropathy which effects gait early and leads to bed confinement
2) ____ has an onset before 20, ataxia to all 4 limbs, dysarthria, muscle weakness, etc and is an ____ inherited disorder due to a mutation on chromosome 9, and often death is due to hypertrophic ____

*********3) _____ has progressive ataxia, oculocutaneous telangiectasia (which is a PORT WINE STAIN THAT EFFECTS THE UPPER EYELID), and immunological deficiencies (leads to common recurrent sinopulmonary infections) and is AR due to a mutation on chromosome 11

Answer 40

1) Spinocerebellar ataxia
2) Friedrich’s ataxia, Autosomal recessive, cardiomyopathy
3) Ataxia-Telangiectasia

Question 41

The most common Akinetic rigid syndrome is Parkinsonism, of which the most common is IPD (Idiopathic PD)

******The three qualities of Idiopathic Parkinsons Disease are ___, ____, and ____******

One might also see hypophonia (reptilian state), Myersons sign (tapping on the head leads to sustained blink response), stooped froward, etc.

Answer 41

Tremor, Rigidity (stiff), and Bradykinesia

Question 42

Other akinetic rigid syndromes all include SLOW (bradykinesia) and STIFF (akinetic) movements ALONG with additional problems like in

no tremors present in any of these**

1) _____ has loss of voluntary control of eye movements (vertical gaze)**
2) ____ has PRONOUNCED autonomic dysfunction aka dysautonomia (incontinence, impotence, anhydrois, etc…)
3) ____ has both cortical and basal ganglionic dysfunction that has CORTICAL sensory loss, apraxia, myoclonus, aphasia, etc…

Answer 42

1) PSP (Progressive supranuclear palsy)
2) MSA (Multiple system atrophy)
3) CBD (Cortical basal ganglionic generation)

Question 43

___ is irregular, brief, “dancelike” movements that can be incorporated into purposeful movements

___ is writhing, sinuous movements often in combination with chorea

___ is sustained muscles contractions that produce twisting and repetitive movements and abnormal postures

____ is large amplitude, flinging movement, usually from the proximal part of an extremity

____ is brief, rapid, repetitive, seemingly purposeless stereotyped action that may involve single or multiple muscle groups

Answer 43

Chorea

Athetosis

Dystonia

Ballism

Tic

Question 44

The gradual onset and progression of chorea and dementia caused by inherited tri-nucleotide repeat gene detect on chromosome 4 and is AD inheritance is ____

____ occurs in kids as a complication of a previous infection with group A hemolytic strep, characterized by unilateral choreiform movements which when mild can be confused for restlessness of fidgeting

Answer 44

Huntington’s disease

Sydenham’s chorea

Question 45

Dystonic movements and postures without other signs is called ____

Seen with torticollis (cervical twisting), arm held in hyperpronated position and leg held in extension with pronated and inverted of the foot

Can use low doses of ___ to treat ITD, and if there is dystonia in ONLY one area instead of being called ITD, it is called ____ torsion dystonia (confined to one area, versus ITD which has multiple areas associated with it) and the best treatment for FTD is ____

^** Examples of Focal TD are Blepharospasm, Oromandibular dystonia, Spasmodic Torticollis, and Writers cramp

Answer 45

Idiopathic torsion dystonia

Levodopa , Focal, BOTOX (Botulinum Toxin)

Question 46

**Wilson’s disease is a disorder of COPPER metabolism that effects the ___ and ____ systems ******* and usually presents in childhood or young adult life

^** Can be treated via ____

Answer 46

Neurologic and hepatic

Penicillamine

Question 47

If a patient drinks alcohol and it decreases the tremor temporarily, it is ___ tremor aka Benign familial tremor

^** Usually progresses slowly over years to decades

Answer 47

Essential

Question 48

____ must have a decline in memory and at LEAST on other cognitive function like apahsia (difficulty speaking), apraxia (motor planning), etc….

Answer 48

Dementia

Question 49

If a patient has progressive deterioration of specific cognitive functions like aphasia, apraxia, or agnosia with plaques and tangles seen on microscopic exam, they have _____

The best way to treat this is a _____ like Donepizil, Rivastigmine, or Galantamine + an ____ with the best option being ____

Answer 49

Alzheimer’s Disease

AChE inhibitor + NMDA receptor antagonist, Memantine

Question 50

If a patient ONLY has memory loss, it is called ____ (remember, they must have loss of another cognitive function to meet the criteria for dementia)

^** Could be a precursor to Alzheimers disease

Answer 50

MCI (Mild Cognitive impairment)

Question 51

____ is characterized by dementia, parkinsosnian symptoms (bradykinesia and rigidity, but no tremor) and PROMINENT psych symptoms like visual hallucinations

Classic hallucinations are children or animals*

****These patients are also unexplained periods of markedly increased confusion that mimics delirium**

So if lewy bodies are seen in the niagrostriatal system (midbrain) it’s ____ and if they are seen everywhere (cortical) then it’s ____

Answer 51

Diffue Lewy Body Disease

PD, Diffuse lewy body disease

Question 52

**** WILL BE A TEST QUESTION*******

Dementia, gait disturbance, and urinary incontinence is the triad for ____

There can potentially be reversed via a ____ with the most likely improvement being the ___ disturbance

Answer 52

Normal Pressure Hydrocephalus

Ventriculoperitoneal shunting, gait

Question 53

____ disease is a young person condition and characterized by a defect of NOTCH3 gene on chromosome 19, causing progressive degeneration of smooth muscle cells in blood vessels

Manifests as migraine, headaches, and TIAs or strokes

Answer 53

CADISIL