T3-Neuro Flashcards
UMN symptoms are _____ while LMN symptoms are _____
Stiff, spastic
Limp, low reflex, atrophic.
What are components of executive function during a neuro exam?
Attention, language, memory, calculations.
What is congenital aniscoria?
A natural, non-pathological difference in pupil size. Can be up 0.4 or up to 1.
T/F: in differentiating between Bell’s palsy and strokes, ask the patient to raise their eyebrows. if only one eyebrow raises, then consider Bell’s palsy.
True.
The frontalis muscle is innervated by ***
Other than facial paralysis, what other s/s might you see in Bell’s?
Hyperacusis (stapedis muscle) and changes is taste.
When you ask a patient to stick out their tongue, does it point to the weakened or the strong side?
It deviates and points to the weak side - CN XII is Ipsilateral.
When you test for muscle strength, support the joint so that you can isolate the correct group of muscles as much as possible.
MSK injury - test for ____
PMS
Pulse
Motor
Sensation
When you’re testing for sensation. Deficit, ask the patient to quantify in a % of the good side: “I can feel about 50% of my left arm compared to my right”
Radiopedia.org
TIA follow up appointments - what is the POC?
Lifestyle management
Anti-platelet, statins, BP management, manage a-fib, quality of life, living will, CV assessment.
2 main types of seizures
Focal
Generalized
If patient presents with history of possible seizure what questions should you ask?
Blood on pillow/cheek/tongue bite?
Incontinence
Duration (capture on film or set timer)
Pre-octal aura/post-ictal confusion?
ETOH history
If a patient says they got tunnel vision or light headed before their “seizure” what are you more likely to consider? What if they said they felt like their stomach was going up like in a roller coaster?
Syncope
Seizure
Todd’s paralysis
Weakness in the affected muscles after seizure
Labs/imaging to get after a seizure
CBC, CMP, electrolytes, LFTs, ETOH Drug screen
MRI for brain tumor
ECG for cardiac causes.
Pt whose siezures are not controlled on 2 drugs likely won’t have control with 3
30% recurrence risk after the 1st seizure
80% recurrence risk after the 2nd
What medication is a good one to start for seizures in Primary care because it doesn’t need titrations?
Keppra
Menstrual cycle can have effects on epilepsy
If your patient is on seizure meds long term, what are some considerations?
Osteopenia/porosis
AEIOU TIPS for AMS
Alcohol, Acidosis
Epilepsy, Environmental, Electrolytes, Endocrine
Infection
Overdose, Oxygen deficiency
Underdose, uremia
Trauma, tumor
Insulin
Psychogenic/poison
Stroke, shock
Abx for meningitis
Immunocompromised or young/old?
Vanc, Ceftriaxone and acyclovir.
Add ampicillin.
3 categories of “dizzy”
Lightheaded/pre-syncope
-orthostatic hypotension
-vasovagal
-hypoglycemia
-hyperventilation
-arrhythmia
-dehydration
Vertigo/sense of movement when they are not moving
-vestibular
-inner ear disorder
Disequilibrium/unsteady on feet like they’re going to fall
-vestibular loss
-proprioception loss (DM neuropathy)
-impaired cerebellar
What is the worst kind of nystagmus?
Bidirectional and vertical.
Unidirectional and horizontal can be a sign of BPPV
BPPV - 50% trauma/infection, 50% unknown cause
BPPV has nystagmus that’s called
Georotational extinguishing nystagmus
May take a few seconds for onset. May take 10-30sec to extinguish
One way to differentiate between Lewy Body Dementia and Parkinson’s Dementia?
Lewy Body - movement disorder and dementia onset at the same time
Parkinson’s - movement disorder 1st then dementia many years later.
Don’t forget ______, _____ and _______ in a dementia work up?
ETOH, TSH, folate, vit B12, SYPHILIS!
Aricept used for?
Dementia - mild to moderate. Can start in PC.
What medication is used for more severe dementia?
Namenda.
Could you give SSRI’s to a dementia patient who is depressed?
Usually not overly effective, but worth the try. Low dose SSRI.
What are some things other than DM that can cause peripheral neuropathy?
Renal failure
Vit B12, B1, B6 deficiency
B6 toxicity
Alcoholism (Mg and B1 deficiency)
Vascular damage (PVD)
Toxins
If a patient with no past medical history presents with peripheral neuropathy, what work up would you want to do?
DM screens, vitamin screens, ETOH, kidney fxn, protein electropheresis looking for monoclonal spike (GBS), soft/sharp, 2-point descrimination, temp and vibration?
If a paralysis is progressing after 4 weeks is it GBS?
No. GBS progression stops after 2-4 weeks.
GBS and other autoimmune disease are associated with check point inhibitors in cancer treatment.
Your patient has a tremor that worsens with movement but is not present at rest. What is it called and what could be the cause?
Intention tremor - cerebellar, ETOH, MS
your patient has a tremor that is bilateral and symmetric in his arms, and head. His voice is hoarse with stress and fatigue and improves with alcohol.What kind of tremor is this?
Essential.
Progressive and benign
T/F: Intension tremors are progressive and benign.
False. Essential tremors are.
What is the McDonald criteria?
Used to Dx MS - 2 distinct episodes lasting 24hrs occurring at least 30 days apart with at least 2 different locations.
Trigeminal neuralgia - prescribe _____ then refer to _____
Carbamazepine
Neuro
Most brain tumors are ________. Search for _______
Metastatic
Other cancers.
