Popcorn- LL Flashcards
What is the most frequent HA?
Tension HA
What is the MC HA leading to a PCP visit?
Migraine
What are the 4 primary HA?
Migraine, Tension, Trigeminal (cluster), New Daily
Which headache’s ADE include Photophobia, Phonophobia, and Nausea?
Migraine (mc in Women)
- triggers = emotional stress, hormones
What HA is associated with trigeminal system dysfunction/ Pain
Migraines
whats more common, a migraine w or w/o aura?
W/o
Aura = feeling, sxs before a migraine
Are auras common in Menstrual migraines
No
What is abortive Tx for Migraines
NEAT- Ass
NSAID, Ergotamins, Acetaminophen, Tripans,
AntiemeticSS
Tx for mild -mod Migraines? NAA
1st line = NSAID
2nd line = Acetaminophen
3rd line = ASA/Caffiene
Tx for mod - severe Migraines? Try eating opioids -
1st line = Triptan
2nd line = ergots
3rd line = opioids
What does botulism block?
Substance P
“flip the b to a P”
What is associated with Tension HA?
Vice-grip, pericranial myofascial pain
“hands around the head” Bilateral,
Acute Tension HA treatment? NAA
1st line: NSAID, Acetaminophen, ASA
* No opioids, butalbital, muscle relaxant*
Chronic Tension HA treatment? T AD AC TLB
TCA (North America)
AD (Mexico Venezuela)
AC (Togo)
These countries all have tension!!
TCA (amitriptyline, Nortiptyline) Antidepressant (Mitra + Ven) Anticonvulsants (Topiramate, Gabapentin)
Tizanidine, Lidocane, Botulism
Cluster HA = Many times a day (8), mostly Episodic, Chronic.
What else is Popcorn to Cluster?
Cluster: conjuctival injection, lacrimation, Nasal conjection, Rhinorrhea (nose crap)
Cluster tx? “100% Sumatran Coffee,”
1st line = 100% O2, for 15 mins, Sumatripan, Corticosteroids.
Prophylatic = Verapamil
Popcorn New Daily headache?
1986, Self-limiting, bilateral, (like Migraine = Nausea, photophobia, phonophobia)
Red Flags Headache
New onset, (thunderclap = worst HA ever), Preg or post-partum severe HA, wakes patient from sleep, Weight loss, persistent morning headaches
Red Flags Headache
AMS, Confusion, Fever, Nuchal rigidity, Papilledema, Tender temporal artery, Severe HTN
Popcorn Pseudotumor Cerebri
Chronically ICP, Growth Hormones, Tetracyclines, Abducens palsu, Photopsia, backpain, retrobulbar pain
Pseudotumor Cerebri PE?
“ Obese patients vomit alot”
Obesity, Papilledema, Visual fields, Abducens palsy
Pseudotumor Cerebri TX?
“Fast weight loss, No salt or carbs
Furosimide, Weight lose, Stop Na, Carbonic anhydrase.
What are overused meds that lead to headache? “Buy others alcohol”
Butalbital, Opioids, ASA
SXS of med overdoes HA? “Megan Never Drinks Iced Amoretto”
Memory, Nausea, Diff conc., Irritable, Asthenia
Popcorn for Temporalis Arteritis. “Giant Elephants Crunches my Head”
Giant, High ESR (100), High dose Corticosterioids (only Tx) inflamed temporal arteries. Old men can’t wear hats
What is Tic Douloureux?
Compressed Trigeminal , any normal stim (shaving) causes pain. Sharp electrical pain
How do you dx and tx trigeminal neuraglia?
MRA (artery) and vascular decompression
Trigeminal neuraglia red flags? “2,3,4”
Bilateral, trigeminal sensory lose, under 40
Charcot - Marie - Tooth disease popcorn
“Country Music TV 1”
MC hereditary peripheral neuropathy. CMT1 = Dance (footdrop, pes cavus, hammer toe) No DTRs
Porphyria popcorn
“Aut dominates many harum, Sara, Angela, and Holly are very painful”
Autosomal Dom. Metabolic Heme dysorder, HAV porphoria, Sharp pain, agitation, hallucination, extreme pain
DM peripheral neuropathy popcorn.
Most common peripheral neuropathy in western world.
Distal, symmetry, neuro cachexia, Painless, Overactive sweat, Ataxia, bad gait, Syncope
DM peripheral Tx?
Dont overthink it
Glucose, Foot care, education
Hypothyroidism peripheral popcorn
Proximal myopathy = MC is Carpal tunnel
Tx = correct hypothyroidism
GI peripheral popcorn
No gluten, need more B12 and Vit E
infectious peripheral popcorn
Borrelia (lyme), Deer tick (ixodes dammini)
Facial neuropathy
Vit B12 (cobalamin) peripheral popcorn
Pernicious Anemia, Glossitis, absent achiles reflex.
Tx = Vit B12 supplement
Vit B1 (thiamine) peripheral popcorn
Beri beri disease
Chronic alcohol abuser, recurrent vomitter
Tx = parenteral thiamine replacement
Carpal Tunnel Synd popcorn
Compressed Medial nerve
Office worker, female, obesity, small space risk, Shake out & flick sign,
Thenar Atrophy
TX = NSAID, Surgery
(Ulnar neuropathy) Cubital Tunnel Synd popcorn
Pass btw the medial epicondyle and olecrenan. Tinel elbow sign. 5th and half of 4th finger sensory and motor.
(Ulnar neuropathy) Cubital Tunnel Synd Tx?
Use elbow pads
Surgical decompression
Radial neuropathy popcorn
Wrist drop, weak finger extension, Keep triceps reflex, heal spontaneously.
Tx: Cock-Up wrist or splint: No Surgery
Meralgia Paresthetica (lateral cutaneous femoralneuropathy) Popcorn
Numb lateral quad,
Tx: no tight belts, lose wt, NSAIDs
Peroneal neuropathy popcorn
Foot drop, L5 radiculopathy.
No leg crossing, heals spontaneously
Bells Palsy Popcorn
CN 7 & LMN, associated with HSV, DM, & 3rd trimester.
Unilateral face paralysis (Whole Face)
No corneal light reflex
Bells Palsy vs Stroke
“Stroke Spares” the forehead = wrinkles/ bilateral
How can you test for Bells Palsy?
” Garima & Megan love Chololate Blue Bell ice-cream”
Godalimuim MRI, Burreli, CT - Bells palsy
How can you tx Bells Palsy? “Eat Vanilla Pudding”
Eye protection, Valacyclovir, Prednisone
CRPS popcorn
Triad: Burning, auto dysfunc, trophic changes = after surgery.
Trauma = trigger
Hot ashy hands
CRPS diagnosis & Tx?
“Budapest Bones Need proper and neat sorting”
Budapest - clinical diag
Bone density scan
Tx: NSAID, Prednisone, Anticonvulsants, Nortriptylline, SNRIs
Tourette’s popcorn
Men, ADHD, OCD, Motor and phonic tic,
Echopraxia (mimic), Copropraxia (dirty gesture)
Echolalia, Palilalia (repreat phrase faster and faster)
How can you TX Tourette’s? “cartman cant genuinly treat Hankey (christmas poop) better”
1st Line = CIBT, Clonidine, Guanfacine.
Tetrabenazine, Haloperidol, Botulinum
What time of sleep is regenerative?
N3
Can you move when your dreaming? When are you dreaming
No way, Rem sleep
What is the Mallampati scoring? “mallampati is a mouth full”
Measures airway . 1 = tonsils, uvula, ext are visable, 4 = only hard palate is visible
In general what tests can diag sleep disorders? “Pa Students Hardly Ever”
Polysomnography, surface electromyogram, Home sleep test, Epworth Sleepiness scale.
Who gets insomnia?
“WOULD” how do you diag?
Women, older, un-employeed, Low SES, divorced.
Diag with 3 sxs per week.
Sleep tx? “Hey Bitch, Ambien and lunesta makes dolly sleepy!”
Hygiene, Benzo, Ambien and lunesta, Melatonin, Doxepin, Suvorexant
OSA popcorn
Obese, Male, Old, High Mallampati score
OSA Diag and Tx? “Polly wants a cracker”
Polysomnography
Weight loss, avoid alcohol, CPAP
Narcolepsy popcorn
Narcos: killed Orexin, Emptied 15 clips, murdered 8 other
Narcos: killed Orexin, Epworth 15+ score, MSLT under 8 mins
Tx Narcolepsy? “Pablo murdered many anxious cops fleeing the southern villa”
Provigil, modafinil, methyphenidates, amphetamines. Cataplexy = fluoxetine, tricyclics, Sodium oxybate, venlafaxine.
Circadian = think shitty schedule
Shift workers, grave yard shift
Parasomnia = N3
“paranatural phenom”
NREM = menses, sleep deprivation, emotional, Sleep terrors: tachy, sweaty, fear!
what are the 3 patheways of CNS infection?
Blood, retrograde up a neuronal path, direct contiguous
What does an LP measure? CC GG VP
Cell, Culture, glucose, gram, protein, viral
When should you not do an LP?
Cushings triad (repsiratory depression, Brady, HTN)
Mass, skin infection, severe coag
Is a little blood in vial 1 of 4 ok?
Yes, if theres blood in all 4 = subarachnoid hemorrhage, intracranial hemorrage, cerebral infacrt.
Encephalopathy popcorn
VIRAL»Bacterial, Paraneoplastic.
No sign of meningial irritation (photophobia, nuchal rigidity)
What can you see in a the PE for Encephalopathy?
Fundoscope: Papilledema, Retinitis
Skin = alot of shit
How to diag Encephalopathy?
“Look sick? Cancel the STEPS
1st = MRI, then CT.
If patient looks sick, do a CT and Serum electrolytes, Thoat swab, sputum EEG, Peripheral smear, & Sputum culture.
Encephalopathy hyponatremia is caused by
Ricketssia and SIADH
* on the test*
How can you stablize an encephalitis patient? VENMO
Ventilate,
ET tube
n’
MOnitor electrolites
Empiric Encephalopathy treatment?
* on the test*
A! Da Bitch Got Incarcerated:
Acyclovire 10 mg for 8 hours.
DVT, Bacterial, GI, Increased ICP
Meningitis Popcorn.
“Fondling Noren produces nasty favors”
Fever, photophobia, HA/N/V, neck stiffness,
Bacterial meningities POPCORN
Adults = penetrating injury Kids = brith canal/placenta Rapid bact growth!! Neonate = S. agalactiaa (lactating) Babies = S. penumo Teens = n. meningitides Adults = s. penumo
How can you diag Bact Meningities?
“Big ass lips can cause chaos”
Blood culture x2
Antibiotics
LP
CBC, CMP, COags
Bacterial meningitis empiric tx?
“Another 50 Cent Victim”
Cetf/cefo + Vanco+ Amp (50)
+ acyclovir
Meningitis tx for S. pneumo N. meningitides Listeria H. Flu
S. pneumo - Vanco + Cephalo
N. meningitides - cephalo
Listeria - Amp/ Pen G
H. Flu - Cephalo
Is Bact meningitis bad?
Emergency, untreated = 100% fatal
Can you prevent Bact Meningitis?
* on the test*
Yes!
<1 month = Rif or Cirpo
>15 year = Ceftriaxone
Neonates (S. pneumo) = Quad meningitis A vax - Menactra (9months to 55yo) - Menveo (2 months to 55Yo) Meningitis B vas - Trumenba -Bexsero
Whats Aseptic Meningtitis
TX (Install the NBA)
meningitis w/o infection - cancer, meds, SLE
-TX = Bactrim, NSAIDs, Chemo (Azathioprine, Infliximab
What is drug resistant epilepsy?
seizure occur with 2 medications (15% of pts)
How does epilepsy kill you?
SUDEP
sudden unexpected death in Epilepsy
FOCAL siezures popcorn
Motor (shake), Aware, Hemisphere that spreads
GENERAL siezures
From both sides of the brain
Associations
Temporal lobe
Frontal lobe
Juvenial myoclonic
Lennox-Gastaut
Temporal lobe - MC, good outcome
Frontal lobe - less favorable
Juvenial myoclonic - lifelong, genetics
Lennox-Gastaut - drug resistant, behavioral decline
MC causes of Epilepsy?
Structural (stroke, head trauma/tumor)
Infection - encephalitis
When do you do an MRI
What about CTs
MRI = any new onset
CT = if MRI isn’t available
What do you look for in an EEG?
Epileptiform btw seizures
When do you treat Seizures?
“USE NOS”
Unprovoked seizures,
Sig brain abnormality,
Epileptiform on EEG
Nocturnal seizures
Old
Social factors (driving, work)
ADE of drugs Wt gain Wt lose Kidney stones Hyponatremia Ostepenia Cognition Mood
Wt gain - Valproate Wt lose - topiramate, zonisamide Kidney stones - topiramate, zonisamide Hyponatremia - Carba, oxcarba, zonisamide Ostepenia - Valproate Cognition - All Mood - All
What drugs increase the risk of seizures in epileptic patients?
“Better make a clean dermal cut”
Buproprion, maprotile, ampxapine, clomipramine, demerol, cipro
Seizures: enzyme inducers cause
Birth control to fail
valproate = never use in pregs
When is surgery needed for epileptic pts?
Drug resistant, MC is a temporal lobe resection
What are the three Epileptic diets? (LAKE)
Keto, low glycemic, Atkins
What is status epilepticus
cont. seizure > 5 mins w/o return to baseline
status epilepticus tx?
Ben loves valleries Pu, but denies rectal
Benzo, Levetiracetam, valproate, phenytoin, diacetam PR
If a stroke occurs on the left side of the brain what side of the body is affected?
Right (cross over)
CN 7 vs stroke on facial paralysis?
Stroke spares forehead,
CN 7 paralizes all (seven continents)
85% of strokes are
Ischemic
What does the Cincinnati Pre-hospital stroke scale measure?
Face droop
Arm drift
Slurred speech
What can mimic a stroke
Hypoglycemia (<50)
What is an ischemic stroke?
Blockage (Thrombotic = atherosclerosis - large vessels) (Embolic = Left side or Artery to Artery stroke - Lacunar = smaller vessels)
AIS vs TIA
AIS
- sudden, stop blood perfusion, > 24 hrs, permanent damage
TIA (no acure infarct)
- Sudden, transient lack of blood, <24 hrs, < 1 hr, No permanent damage
How can you risk stratify stroke risk
ABCD2 - 2 day risk
Age, BP >140/90, Clin sxs, Duration >60, DM
What is the penumbra
zone of reversible tissue ischemia with a necrotic core
Window to give tPA for stroke
3-4.5 hours
FAST score for stroke
90% sensative if you all cincinnati shit
AIS ED stroke triage steps? triage Medical care CT and labs Tx
triage - tPA
Medical care - O2, BP, Wt, EKG CT
CT and labs- CT, ED
Tx - tPA, HTN, H/N/V
What is MERCI
Cork-screw app that removes clots
What is the main cause of Hemorrhagic Stroke
HTN»_space; ICP, rupture blood vessel
Arteriovenous malformations tx
Coil embolization, clip
Glasgow coma scale
3 = worst 15 = normal
CNS herniation
- subfalcine
- Transtentorial
- tonsillar
- subfalcine - contra leg weakness
- Transtentorial - CN III shit
- tonsillar - obtundation
Subarachnoid Hemorrhage Tx
Stool softener, cough suppressants
Tx fore post stroke depression
SSRI
