Review Flashcards
Stocking glove pattern of sensory origin suggests what?
Peripheral nerve disease - PNS
What are some diagnosis that tells you if the CNS is involved?
Migraines
TIA/CVA
Demyelinating lesions
Infections
What are some diagnosis that tells you if the PNS is involved?
Diabetic neuropathies
Guillain-Barre Strohl Syndrome
Poly/Mono Neuropathies
Amyotrophic Lateral Sclerosis
Focal back pain with urinary incontinence suggests what?
Spinal cord origin - CNS
What is postictal?
Recovery period following seizure activity
What does graphesthesia test?
Ability to identify numbers written on the palms
What does stereognosis test?
Ability to identify objects in the hand
What is a CVA?
Sudden death of brain tissue due to lack of oxygen and blood flow to the brain.
- Ischemic 10x > hemorrhagic
What is a TIA?
“mini stroke” similar sxs to a CVA but usually lasting only a few minutes to <24 hrs.
- w/o infarct
- causing no permanent damage.
What are the SNOOP4 red flags?
- Systemic disease or symptoms
- Neurologic signs or symptoms
- Onset that is sudden
- Older than 40 years of age
- Progressive worsening
- Postural
- Precipitated by Valsalva maneuver or exertion
- Previous headache history with new feature
Pt comes in with a “thunder-clap” HA, states pain worsens when laying down, what imaging would you do to diagnose the pt?
CT w/o contrast
What is first line tx for cluster HA?
100% Oxygen
Idiopathic intracranial hemorrhage is MC’ly seen in who?
Obese women of childbearing age
What is the MC HA?
Tension HA
Pt comes in with ear pain, jaw claudication, and has hx of polymyalgia rheumatica what do you suspect pt has and how would you diagnose?
- Temporal arteritis
- Get ESR done (would be elevated)
- Start high dose steroids
- Biopsy to confirm
Pt who is a “frequent flyer” comes into the ER with a HA but states this HA is different that usual, what test would you perform?
CT scan then LP
What is it called when pt has purposeless, involuntary, repetitive movements such as lip smacking, chewing, picking at clothings, may become aggressive if restraining is attempted?
Automatisms
seen in complex partial seizures
What type of syncope is caused by fear of their blood being drawn?
Vasovagal syncope
What type of syncope is caused when a pt is wearing a tshirt that is tight around their neck and when they move their neck or head it causes them to pass out?
Carotid sinus hypersensitivity
What is the MCC for a pt to experience multiple epilepsy episodes?
Poor anticonvulsant medication compliance
What is delirium?
An acute period of cognitive dysfunction due to medial disturbances or condition
What is dementia?
A progressive deterioration of intellectual function.
What are some general characteristics of lewy body dementia?
- Parkinsonian syndrome
- Visual hallucinations
- Fluctuations in attention and alertness
- Rapid eye movement
What are some general characteristics of vascular dementia?
- Multi-infarct
- Diffuse white matter
- multiple small areas of ischemic damage
What are some general characteristics of alzheimers?
- Quantity of senile plaques
- Nerofibrillary tangles
- Progress at steady state
What would you see on a CT or MRI in a pt with alzheimers?
- Diffuse cortical atrophy
- Enlargement of the ventricles
What are the 4 characteristics of narcolepsy?
- Sleep attacks
- Cataplexy (laughing then fall asleep)
- Sleep paralysis
- Hypnagogic hallucinations.
Obstruction of air flow in sleep apnea is typically located where?
Oropharynx
What would you use if pt declines CPAP or BiPAP?
Oral appliance (displaces the tongue and soft airway tissue)
What is the difference between snoring vs OSA?
- Snoring: partial obstruction of the airway
- OSA: complete obstruction of the airway
What is a Tonic-Clonic (Grand Mal) Seizure?
- Bilaterally symmetric and without focal onset
- Begins with sudden loss of consciousness
What is a Absence Seizure (petit mal seizures)?
Patients “stares off into space” and then returns to normal activity after a few seconds
What is Status Epilepticus?
Continuous seizure activity > 5-10 minutes or >2 seizures without full recovery
- always check finger stick blood glucose
What is a Generalized Seizure?
- Characterized by loss of consciousness
- Involves disruption of the electrical activity in the entire brain
What is a Complex Partial Seizure?
- Consciousness is impaired
- Accompanied by posticidal confusion
What is a Simple Partial/Focus Seizures?
Consciousness remains intact
A young girl comes into the ER d/t a seizure, she LOC, came back and LOC again. What would you diagnose her with and how would you treat?
- Status Epilepticus
- IV Lorazepam
What is the syndrome called when a pt experiences abnormal involuntary stereotypes movements of the face mouth (lip smacking) tongue, trunk, and limbs. And what is it usually caused by?
Tardive Dyskinesia
- caused by antipsychotic agents.
What type of tremor occurs in a pt with PD?
Resting tremor
Fine toning of the direct and indirect pathway is modulated by what?
Dopamine
What part of the brain is not degenerated in pts with HD?
Basal Ganglia
What tremor occurs when there are movements or when the body is activated and not at rest?
Essentail Tremor
A 73 yr old male pt comes into your office after returning from a trip to Mexico, you notice he has a mask like face, head is tilted forward, and has a pill rolling tremor, what do you suspect the pt has?
PD
Pt presents with a complaint of sudden brief involuntary movements what would you need in order to diagnose the pt?
Pts hx and family history
What are the 4 components to dx PD?
T: tremor (pill rolling)
R: rigidity (lead pipe)
A: akinesia/bradykinesia
P: postural
What are the progressive movement disorders?
HD
PD
Essential tremor
Pt comes in complaining of neuropathy, distal parenthesis, muscle weakness, reports sxs started after a recent respiratory infection. What do you suspect pt has?
Guillain Barre Syndrome