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Clinical Medicine > Test 7 Neuro > Flashcards

Test 7 Neuro Flashcards

1
Q

Risk factors Migraines

A
  1. FH
  2. Obesity
  3. Sleep apnea
  4. Head injury
  5. Femlae
  6. Analgesic overuse
  7. Caffiene
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2
Q

Common migraine S/S

A
  1. Pulsatile, throbbing
  2. Unilateral
  3. Last hours to days
  4. N&V
  5. Photo & phonophobia
  6. Cutaneous allodynia
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3
Q

Aura

A

10-30 min before HA

  1. Scintillating scotomas
    - peripheral flashing lights in periphery
    - pale blind spot that enlarges
  2. Fortification spectrum
    - zig zagging lines
    - teichopsia
  3. Prodrome of inc. excitability/irritability, fatigue, depression, appetite inc./cravings
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4
Q

Basilar migraine

A
  1. Affects basilar artery
  2. HA
  3. Vertigo
  4. Slurred speech
  5. Impaired coordination
  6. NO MOTOR defecits
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5
Q

Hemiplegic migraine

A
  1. Familial
  2. Paralysis on one side of body
  3. May persist for 24h w/o HA
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6
Q

Ophthalmoplegic migraine

A
  1. HA
  2. Eye pain
  3. Vomiting
  4. Ptosis
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7
Q

Mirgainous carotidynia

A
  1. Face, jaw & neck tenderness & swelling over carotid artery
  2. Older Pts
  3. Normal carotid on US
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8
Q

Abdominal migraine

A
  1. No HA
  2. Vomiting
  3. GI pain
  4. Younger Pts
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9
Q

Catamenial migraine

A
  1. ONLY occur at menses
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10
Q

When to get CT w/ migraines

A
  1. 1st or worse migraine
  2. New >50
  3. Thunderclap HA
  4. Abnormal neuro exam
  5. Rapid onset w/ strenuous activity
  6. HA awakens from sleep
  7. Meningeal signs - vomiting, AMS, personality changes, stiff neck
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11
Q

Tx migraine

A
  1. Excedrin migraine & NSAIDS
  2. Triptans
    Dihydroergotamine
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12
Q

Antinausea for migraines

A
  1. Reglan
  2. Compazine
  3. Atarax
  4. Phenergan
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13
Q

When do you get rebound HAs & what causes them?

A

Overuse of meds >10days/mo

  1. Acetaminophen
  2. Narcotics
  3. ASA
  4. NSAIDS
  5. Ergot alkaloids
  6. Triptans

If overusing triptans, stop & use steroids

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14
Q

When do you start prophylactic migraine meds & what do you give?

A
  1. > 2 HAs/wk
  2. Severe
  3. Duration >2 days
    Continue for 2-3 mo then taper/DC
  4. Beta blockers
  5. Tricyclic antidepressants
  6. Anti-seizure meds (Depakote, Topamax)
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15
Q

Risk factors Cluster HAs

A
  1. Men
  2. 20-40 yo
  3. FH
  4. Tobacco
  5. Head injury
  6. Shift work
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16
Q

S/S cluster HA

A 
Excruciating, stabbing pain, unilateral, behind eye, jaw, teeth, 15min-3h 
Must have 1 of:
1. Lacrimation
2. Ipsilateral nasal discharge
3. Ipsilateral flushing/sweating
4. Conjunctival redness 
5. Horner's syndrome - ptosis, miosis
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17
Q

Tx Cluster HAs

A
  1. Triptans
  2. Oxygen

Prophylaxis:

  1. Verapamil
  2. Maybe steroids
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18
Q

S/S tension HAs

A

Myofascial origin

  1. Vice-like, gripping band HA
  2. Forehead-occiput bilat
  3. Radiates to posterior neck & trapezius
  4. Lasts 30mins-7days
  5. No N/V, photo/phonophobia, pulsatile, not worse w/ activity
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19
Q

Risk factors Tension HAs

A
  1. Stress/anxiety
  2. Depression
  3. Overwork
  4. Lack of sleep
  5. Posture
  6. Marital/family dysfunction
  7. Conversion
  8. Malingering
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20
Q

Tx Tension HAs

A
  1. Exercise
  2. Relaxation/Counseling/Yoga
  3. PT/acupuncture
  4. NSAIDS, tylenol
  5. Myofascial trigger point injections
  6. TCAs/SSRI
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21
Q

Causes & Risk factors Pseudotumor cerebri

A

aka idiopathic intracranial HTN

  1. Women 15-44
  2. Obese women
  3. Accutane
  4. Tetracyclines
  5. OCs
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22
Q

S/S pseudotumor cerebri

A
  1. Retro-orbital pain
  2. Worse w/ eye mvmt
  3. Throbbing
  4. Worse in am
  5. N&V
  6. Monocular/binocular vision loss
  7. Pulsatile tinnitus
  8. Neck pain
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23
Q

Dx pseudotumor cerebri

A
  1. Papilledema

2. LP - high opening pressure

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24
Q

Tx pseudotumor cerebri

A
  1. Wt loss
  2. Low Na diet
  3. Avoid sulfa meds
  4. Diuretics
  5. Steroids maybe
  6. NSAIDS/TCAs
  7. LP
  8. Surgery - optic nerve decompression, CSF shunt
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25
Q

Risk factors & Triggers Trigeminal neuralgia

A
  1. Women >40
  2. MS
  3. Washing face
  4. Brushing teeth
  5. Chewing
  6. Cold air
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26
Q

S/S trigeminal neuralgia

A
  1. R side more common
  2. Stabbing/electric shock
  3. Assoc w/ facial spasm
  4. Attacks last <2 mins, dailry/monthly
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27
Q

Tx trigeminal neuralgia

A
  1. Tegretol
  2. Maybe other anti-seizure meds
  3. Maybe baclofen, capsaicin, gamma knife, microvascular decompression
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28
Q

S/S concussion

A
  1. Disorientation
  2. Amnesia
  3. Confusion - vacant state, delayed answers to questions, poor concentration
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29
Q

Grading concussions

A
  1. Ding - confusion, no LOC, sxs 15 min

3. LOC

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30
Q

Glasgow coma scale

A
  1. Eye opening
  2. Motor response
  3. Verbal response

Minor: 13-15
Moderate 9-12
Severe <8

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31
Q

Red flags of concussion

A
  1. Mental status changes
  2. LOC >60s
  3. Pupillary asymmetry
  4. Vision changes
  5. Muscle/sensory deficits
  6. Cerebellar dysfunction - gait/ataxia, finger to nose testing
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32
Q

When do you need a CT w/ concussion?

A

Seizure, neuro deficit, anticoagulants

  1. Glasgow 60yo
  2. Basilar skull Fx
  3. Moderate pretrauma amnseia >15m
  4. Drug/alcohol intox
  5. High risk injury
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33
Q

S/S basilar skull Fx

A
  1. Battles sign - mastoid process, ecchymosis
  2. Raccoon eyes
  3. Hemotympanum
  4. CSF leakage via nose/ears
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34
Q

Steps to return to sports w/ concussions?

A
  1. Asymptomatic & med free x24h
  2. Nonimpact aerobic exercise to inc. HR x24h
  3. Sport-specific light drills x24h
  4. Non-contact training drills x24h
  5. Full contact practice x24h
  6. Return to play
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35
Q

S/S subdural hematoma

A 
Bleeding btwn dura & arachnoid
Tearing of the Bridging veins*
1. Confusion
2. Slurred speech 
3. HA
4. Lethargy
5. LOC
6. N&V
7. Weakness
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36
Q

Tx subdural hematoma

A

Small - burr holes

Large - craniotomy to evacuate clots

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37
Q

S/S & Tx epidural hematoma

A 
Bleeding btwn dura mater & skull
From trauma tearing of Middle meningeal artery*
Biconcave lens on CT
1. Initial LOC
2. Then lucid
Talk & die

Tx - surgical evacuation, ligate bleed

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38
Q

S/S subarachnoid hemorrhage

A

Bleeding into subarachnoid space - usually due to rupture of cerebral aneurysm

  1. Thunderclap HA
  2. N&V
  3. Stiff neck
  4. Confusion
  5. Seizure
  6. Xanthochromia
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39
Q

What is the most common type of stroke?

A

Ischemic

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40
Q

Risk factors of aneurysm

A

Usually develop at branching points of arteries

  1. Old Black women
  2. HTN
  3. Straining
  4. Cocaine/amphetamines
  5. Blood thinners
  6. Alochol
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41
Q

What is the most common site of aneurysm?

A

Anterior communicating artery

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42
Q

Management goals of hemorrhagic stroke

A
  1. Lower BP
  2. Monitor cardiac dysrhythmias
  3. ICP monitoring
  4. Normothermia
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43
Q

Causes of hemorrhagic stroke

A
  1. HTN
  2. Aneurysm
  3. AV malformation
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44
Q

Causes of ischemic stroke

A
  1. Thrombotic - atherosclerosis
  2. Embolic - carotids & heart
  3. Lacular infarct
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45
Q

Risk factors of ischemic stroke

A
  1. HTN
  2. Old Fat lazy blacks
  3. FH
  4. CAD
  5. Smoking
  6. Hypercholesterolemia/triglycerides
  7. Aortic arch plaque
  8. Migraine w/ aura in women >35 that smoke &/or use OCs
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46
Q

S/S TIA

A

Sudden onset of neuro deficit

  1. Speech
  2. Monocular blindness
  3. Hemiparesis
  4. Amaurosis fugax

Sx resolve w/in 24h

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47
Q

How much of the carotid is occluded if you can hear a bruit?

A

50%

Dx w/ ultrasoud or MRA

Angiography Gold std but invasive

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48
Q

What are lacunar infarcts?

A

Occlusion commonly affecting caudate, thalamus & putamen

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49
Q

S/S Anterior cerebral artery occlusion

A
  1. Confusion
  2. Amnesia
  3. Personality change
  4. Cognitive changes
  5. Contralateral hemiparesis
  6. Contralateral sensory impairment
  7. If left = expressive aphasia
  8. Eyes deviate toward affected side
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50
Q

S/S Middle cerebral artery occlusion

A

MC embolus

  1. Contralateral sensory/motor deficits
  2. Head & eyes deviate towards infarct
  3. Neglect to affected side
  4. Dysphagia
  5. Initially dec. muscle tone then spasticity develops
  6. Homonymous hemianopsia
  7. If L - global aphasia then Broca’s aphasia
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51
Q

S/S posterior circulation infarct

A
  1. Nystagmus
  2. Ataxia
  3. Vertigo
  4. Dysphagia
  5. Dysarthria
  6. Sensory aphasia
  7. Alexia
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52
Q

NIH stroke scale

A 
0: No stroke
1-4: Minor stroke
5-15: Moderate stroke
16-20: Mod-severe stroke
21-42: Severe stroke
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53
Q

When do you use TPA?

A
  1. > 18
  2. NIH stroke scale 5 or +
  3. <3h since onset of Sxs
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54
Q

Post CVA mgmt

A
  1. Control BP, glucose, fever
  2. Cerebal edema - mannitol, hyperventilation

high risk of depression

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55
Q

Where is the most common site for bacterial meningitis?

A

Subarachnoid space

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56
Q

Where does bacterial meningitis usually come from?

A
  1. Otitis media
  2. Sinusitis
  3. PNA
  4. Immunocompromised
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57
Q

Organisms of bacterial meningitis

A

Infants - Group B beta-hemolytic strep & enteric gram - bacilli

Kids - H. flu, N. meningitidis, S. PNA

Adults

  1. Strep pneumo
  2. N. Meningitidis
  3. Staph

Old people - S. pneumo, E. coli, Klebsiella, listeria

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58
Q

S/S Bacterial meningitis

A
  1. HA
  2. Stiff neck
  3. Fever
  4. Photophobia
  5. Kernig’s sign
  6. Brudzinski’s sign
  7. Skin rash w/ N. meningococcal (petechial)
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59
Q

Tx bacterial meningitis

A
  1. Vanco + Ceftriaxone
  2. Dexamethasone (steroid)

If >50 Add ampicillin

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60
Q

Complications of bacterial menigitis

A
  1. Cerebral edema
  2. Vasculitis
  3. Inc. ICP
  4. Hydrocephalus
  5. Seizures
  6. DIC
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61
Q

Post exposure prophylaxis of bacterial menigitis

A
  1. Rifampin
  2. Cipro
  3. Ceftriaxone
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62
Q

Causes of viral menigitis

A

Much more common but less deadly than bacterial

Kids - Enterovirus, arbovirus, HSV, borrelia burgdoferi, coxsackie

Adults

  1. Enterovirus
  2. HSV
  3. Varicella-zoster
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63
Q

S/S viral meningitis

A
  1. Flu-like Sx
  2. HA
  3. Fever
  4. Malaise
  5. Photophobia
  6. Meningeal irritation
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64
Q

Who gets TB meningitis & Tx?

A 
Immunocompromised
Spreads from lungs
Tx
1. INH
2. Streptomycin
3. Rifampin
4. Pyrazinamide
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65
Q

Who gets crytococcal meningitis & Tx?

A 
Immunocompromised, DM
Cranial nerve palsies
LP - fungal
Tx
1. Intrathecal amphotericin B
66
Q

What is the MCC of encephalitis?

A

Herpes simplex

  1. HA
  2. Fever
  3. Mental status changes
67
Q

Dx & Tx HSV encephalitis

A

LP - PCR GOLD Std
MRI - diffuse edema

Tx - acyclovir, steroids maybe

High risk of neuro defecits

  1. Personality disorders/changes
  2. Dementia
  3. Aphasia
  4. Memory problems
68
Q

What is the leading cause of epidemic encephalitis?

A

Arbovirus

Incubation - 2-18 days after mosquito bite, simmer-early autumn

West Nile - severe in elderly

69
Q

S/S Arbovirus encephalitis

A
  1. Fever
  2. Malaise
  3. Fatigue
  4. Weakness
  5. HA, eye pain, N&V
  6. Occipital LAN
  7. Maculopapular rash
  8. Conjunctivitis
  9. Flushing
70
Q

Dx & Tx arbovirus encephalitis

A

CBC - leukopenia
LP - lymphocytosis, IgM ELISA (+8-21 days after onset)

Tx - supportive

71
Q

CMV encephalitis in HIV Pts

A

Retinitis
Dx - LP - PCR
Imaging - ring enhancing lesions

Tx - ganciclovir & foscarnet

72
Q

Other causes of encephatlitis

A
  1. Rabies
  2. Varicella zoster
  3. EBV
  4. Influenza
  5. Lyme
  6. Cat scratch disease
  7. Rocky mountain spotted fever
73
Q

S/S Stages of syphilis

A
  1. Chancre - 21-90 days
  2. Macular rash, 2-8wks
  3. 1-20 years, CV, neuro
74
Q

What is Tabes-dorsalis

A

Peripheral neuropathy from syphilis
Inflammatory process involving dorsal root ganglion

S/S

  1. Lightning pains in abdomen & legs
  2. Dec. proprioception
  3. Dec. vibratory sense
  4. Dec. DTRs
  5. Argyll-Robinson pupil (accomodate but don’t react)
75
Q

What is Syphilic paresis

A

Frontal lobe dementia
Emotional lability & memory issues
Psychosis

76
Q

Dx & Tx syphilis

A

LP - Fluorescent treponemal Ab test FTA-ABS

Tx - PCN

77
Q

Stages of brain abscesses

A

Cerebritis - abx/fungals

2 - walled off/organized abscess that begins to expand - need surgery

78
Q

How to Tx fungal abscesses

A

Cryptococcus, coccidioides, Histoplaslma, Aspergillosis

All Amphotericin B

79
Q

What is the MCC of cerebral mass lesions in HIV Pts?

A

Toxoplasmosis

CT - ring enhancing lesions
Dx - IgG & IgM
Long term Tx

80
Q

Progressive Multifocal leukencephalopathy

A

Caused by JCV common in immunocompromised
Demyelinating disorder

Dx - LP PCR
MRI - demyelinated white matter

Tx - dec. immunosuppression

SIGNIFICANT neuro dysfunction

81
Q

What is the only proven cause of brain CA?

A

High dose ionizing radiation

82
Q

S/S Brain CA

A
  1. HA
  2. Seizures
  3. Cognitive/personality changes
  4. Focal weakness
  5. N&V
  6. Speech difficulty
  7. Visual changes
  8. Papilledema
  9. CN6 palsy
  10. Gait disturbance
83
Q

Types of benign tumors

A
  1. Meningioma
  2. Pituitary adenoma
  3. Schwannoma
  4. Craniopharyngioma
84
Q

Types of malignant tumors

A
  1. Gliomas
  2. Astrocytoma
  3. Glioblastoma
  4. Oligodendroglioma
  5. Pineal tumor
  6. Medulloblastoma
85
Q

What is the most common kid brain tumor?

A

Medulloblastoma

86
Q

What is the most common type of brain tumor?

A

Meningioma
More common in women
Arise from the meninges in the arachnoid space

CT - dura tail & indentation of brain

87
Q

Grading of meningioma

A

I - Benign
II - atypical, neither cancerous nor benign, grow faster & recur
III - anaplastic - malignant & invasive

88
Q

Tx meningioma

A

Watchful waiting
Craniotomy
Radiation - gamma knf=ife

89
Q

Pituitary adenoma

A

MEN1 gene

  1. Prolactinoma
  2. Growth hormone
  3. ACTH
  4. Nonfunctioning (compress optic nerve)
  5. LS/FSH
  6. TSH
90
Q

Craniopharyngioma

A

Pituitary tumor
Compress optic nerve
Inc. ICP

91
Q

Craniopharyngioma vs. pituitary adenoma

A

C - arrise from cells in Rathke’s duct

P - arise from cells in anterior lobe

92
Q

Acoustic neuroma & S/S

A 
Tumor CN VIII, from Schwann cells
Benign but can cause serious complications
S/S usually unilateral
1. Hearing loss
2. Tinnitus
3. Vertigo
Dx - CT
Tx - Keyhole surgery
93
Q

What is the most common type of glioma & grading?

A 
Astrocytoma 
I - Pilocytic - benign
II - Low grade - benign
III - Anaplastic
IV - Glioblastoma multiforme
94
Q

Ependymoma

A

Block CSF flow - hydrocephalus
More common in kids
Cut it out, XRT

95
Q

Oligodendroglioma

A

Graded 2-3
Slower growing than astrocytoma
Watchful waiting, surgery & CRT
High rate of recurrence

96
Q

What is optic nerve glioma assoc w/?

A

Neurofibromatosis

May compress pituitary gland

97
Q

Pineal tumor

A 
Production of melatonin
Hydrocephalus 
Grades
Pineocytoma - benign
Peneoblastoma - malignant
98
Q

Medulloblastoma

A

Most common kids tumor
Fast growing, high grade
Tx - surgery, XRT, chemo

99
Q

What CA most commonly metastasize to the brain?

A

Lung & breast

100
Q

Neurofibromatosis

A

Type I - von Recklinghausen disease

  1. 6 or + light brown spots (cafe au lait)
  2. Freckles in unsual places (freckles & groin)
  3. Colored bumps on iris (Lisch nodules)
  4. Bony malformations
  5. Aneurysm, HTN
  6. Many develop gliomas

Type II - usually don’t have skin manifestations
autosomal dominant

101
Q

Risk factors for delirium

A
  1. > 60
  2. Prior brain injury
  3. Insomnia, sleep deprivation
  4. Dec. visual/auditory function
  5. Hospitalization
  6. Polypharmacy
  7. Poor nutritional status
  8. Renal/hepatic failure
  9. Alcoholism
  10. Infection
  11. Hypoxia, CHF, dehydration, MI
  12. Metabolic imbalances
  13. CVA, seizures
102
Q

Presentation of dementia

A
  1. New info difficult to learn & retain
  2. Complex tasks hard to perform
  3. Unable to solve simple problems
  4. Get lost in familiar places
  5. Difficulty expressing oneself
  6. Irritable or aggressive behavior
103
Q

Types of dementia

A
  1. Cortical - alzheimers, metabolic
  2. Subcortical - vascular dementia
  3. Mixed - Parkinson’s, Lewy body
104
Q

Risk factors of Alzheimers

A
  1. > 65
  2. Female
  3. FH
  4. Low edu level
  5. Head trauma
  6. Long standing HTN/MI
  7. ApoE
105
Q

Dx Alzheimers

A
  1. Short term emory loss
  2. Aphasia
  3. Apraxia

Dx of exclusion
CT - cortical atrophy, volume loss medial temporal lobe
PET - hypometabolism

106
Q

Tx Alzheimers

A
  1. Cholinesterase inhibitors - Aricept, Exelon, Razadyne

2. NMDA receptor antagonist - Namenda

107
Q

Risk factors multi infarct dementia

A
  1. DM
  2. CAD
  3. HTN
  4. CVA
  5. Smoking
  6. Men

Alzheimer’s meds not effective

108
Q

S/S & Tx dementia w/ lewy bodies

A
  1. Visual hallucinations - auditory, olfactory
  2. Fluctuations in alertness & attention
  3. Periods of staring into space
  4. Men
  5. Alzheimers meds
  6. Parkinson meds
  7. Maybe anti-psychotics
109
Q

S/S Frontotemporal lobar degeneration

A

Picks disease - 40-70 yo, FH

  1. Inappropriate behaviors & actions
  2. Dec. empathy
  3. Lack of judgement/inhibitions
  4. Apathy
  5. Repetitive compulsive behaviors
  6. Lack of hygiene
  7. Speech & language disorders
  8. Mvmt disorders
  9. Lack of awareness of behavioral changes
110
Q

Tx Frontotemporal lobar degeneration

A
  1. SSRIs
  2. Antipsychotics
  3. Alzheimers meds
111
Q

Normal pressure hydrocephalus

A

Dec. CSF absorption due to scarring/fibrosis of arachnoid villus
Ventricles become distended & compress the periventricular tissues/vessels

Causes - Idiopathic, head injury, SAH, meningitis

112
Q

S/S & Dx Normal Pressure Hydrocephalus

A

Can’t think, can’t walk, can’t pee
MRI - ventriculomegaly
LP - Pressure at upper limits of normal

Tx - shunt

113
Q

S/S Vitamin B12 deficiency

A
  1. Weakness
  2. Sore tongue
  3. Easy bruising, bleeding gums
  4. Pallor
  5. Paresthesias
  6. Mood changes
  7. Dementia/memory loss
114
Q

S/S & Tx Wernickes-Korsakoff’s disease

A
  1. Ataxia
  2. Confusion
  3. Opthalmoplegia
  4. Vertical & horizontal nystagmus
  5. Short term memory loss
  6. Confabulation

Tx - Thiamine

115
Q

S/S Progresive supranuclear palsy

A

Related to Parkinsons & FTLD

  1. Blurred vision
  2. Loss of balance
  3. Stiffness & bradykinesia
  4. Dysphagia
  5. Dysarthria
  6. Emotional labile
  7. Apathy/depression

Paralysis of vertical gaze***
Startled appearance

116
Q

Tx progressive supranuclear palsy

A
  1. Parkinson’s meds for mvmt disorders
  2. SSRIs
  3. Alzheimers meds
117
Q

What is a cryptogenic seizure?

A

Don’t know what caused it

118
Q

Causes of seizures

A
  1. Brain tumor, CVA, trauma
  2. Electrolyte abnormalities
  3. Medication overdoses
  4. Drug withdrawals
  5. Drugs
  6. Infection/fever
119
Q

Risk factors for febrile seizure

A
  1. Fever >38
  2. Day care attendance
  3. Developmental delay
  4. Neonatal nursery >30days
  5. FH
  6. Viral infections
  7. Vaccines
  8. 6mo-5yrs
120
Q

Risk factors for recurrent febrile seizures

A
  1. Age <104F)

4. 1st degree relative

121
Q

Absence seizures

A 
5-18 yrs
NO aura 
1. Vacant, dazed expression
2. Pallor
3. Last 10 sec max, several times/day

Usually stop by age 20

Tx - Zarontin, Depakote

122
Q

Generalized tonic clonic seizure S/S & Tx

A

aka Grand Mal

  1. Aura
  2. Tonic - muscular rigidity
  3. Clonic - jerking
  4. Incontinence
  5. Tongue biting
  6. Sudden LOC

Tx - Depakote, Dilantin, Tegretol

123
Q

What seizures have “drop attacks?”

A

Atonic

LOC, head drops, loss of posture

124
Q

Simple partial seizures

A
  1. Sensory weirdness
  2. GI Sxs, flushing
  3. Jerking limbs, paresthesias
  4. Hallucinations, deja vu, jamais vu
125
Q

Complex partial seizures

A

Most common

  1. LOC
  2. Temporal lobe - may travel to frontal
  3. Aura - GI Sxs, sense of fear
  4. Stare, automatisms
  5. Lasts 30s-2 min
  6. May progress to generalized tonic-clonic

Tx - Tegretol, Dilantin
Temporal lobe resection if no improvement w/ therapy

126
Q

Rolandic epilsepy

A 
Type of partial seizure that only occurs in kids 
S/S
1. Face/cheek twitching
2. Drooling
3. Difficulty speaking 
4. Centrotemporal spikes on EEG
5. Often occur only during sleep
127
Q

Gelastic/Dacrystic seizure

A

kids
G - laughing
D - crying

128
Q

Status epilepticus

A

Life threatening!!
Seizure that lasts >30min
2 or + seizures w/o recovery period

Risk factors

  1. Medication
  2. Alcohol withdrawal
  3. Drug OD
  4. Intracranial infections
  5. Cancer
129
Q

Tx status epilepticus

A
  1. Lorazepam/diazepam

2. Check glucose

130
Q

Can you use valproate or carbamazepine in pregnant ladies?

A

No mammary glands

131
Q

What are pseudoseizsures?

A 
aka psychogenic nonepileptic seizure 
Common in females, anxiety attacks, PTSD, conversion disorder
1. Nonfocal - opposite arm/leg
2. Pelvic thrusting
3. Head turning side to side
4. Eyes closed tight
5. Tongue biting limiting top
6. Postictal crying
7. Memory of the event
8. May be triggered by emotional/stressful situations
132
Q

When do you stop/taper seizure meds?

A
  1. Seizure free for 2 years
  2. Normal EEG

No driving w/in 6 mo from last seizure

133
Q

Drugs that can cause Parkinsonism

A
  1. Antipsychotics (Halidol)

2. Metoclopramide

134
Q

S/S Parkinsons

A
  1. Rest tremor - Pill rolling
  2. Rigidity - cogwheeling & lead pipe resistance
  3. Bradykinesia - micrographia, slow, shuffling gait
135
Q

Tx Parkinsons

A
  1. Levodopa/carbidopa

side effects - dyskinesias/choreiform mvmts

136
Q

Benign essential tremor

A

Onset 20-60 yo
Autosomal dominant
1. Action tremor - affects hands & head

Exacerbated by stress/fatigue/stimulants
Alleviated by alcohol & rest

137
Q

Tx Benign essential tremor

A
  1. Beta-blockers

2. Anticonvulsant (Mysoline)

138
Q

Huntington’s chorea

A 
Mid-life onset, autosomal dominant
1. Failing memory
2. Restlessness
3. Lack of initiative
4. Choreiform mvmts
5. Mental decline/dementia
No Tx
139
Q

Restless legs causes

A
  1. Women
  2. Idiopathic
  3. Iron deficiency anemia
  4. Pregnancy
  5. Hypothyroidism
  6. DM
  7. Meds - SSRIs
  8. Caffeine
  9. Smoking
140
Q

Tx Restless legs

A
  1. Dopamine agonists

Mirapex, Requip

141
Q

Upper motor neuron diseases & S/S

A
  1. MS
  2. CVA
  3. Traumatic brain injury
  4. Cerebral palsy
  5. ALS
  6. Muscle weakness
  7. Dec. motor control
  8. Spasticity
  9. Hyperreflexia
  10. Babinskis
142
Q

Lower motor neuron diseases & S/S

A
  1. Progressive bulbar palsy
  2. Bell’s palsy
  3. ALS
  4. Paralysis
  5. Atrophy
  6. Fasciculations
  7. Loss of reflexes
143
Q

Progressive bulbar palsy

A
  1. Lower motor neurons, CN
  2. Progressive paralysis - V, VII, IX, X, XII
  3. Drooling, chewing, dysphagia, dysarthria
  4. Progresses to aspiration PNA 1-3yrs
144
Q

Pseudobulbar palsy

A

Uncontrollable crying or laughing outbursts

145
Q

Amyotrophic lateral sclerosis

A

aka Lou Gehrigs disease
30-60 yo
1. Muscle aches/cramps
2. Weakness, distal upper limbs & progresses inferiorly
3. Dysarthria, dysphagia, spasticity, hyperreflexia
4. Muscle fasciculations*

146
Q

Dx & Tx ALS

A

EMG

Riluzole

147
Q

Risk factors Multiple sclerosis

A
  1. White females
  2. Richer people
  3. Northern latitude
  4. 15-60yo
148
Q

Types of MS

A
  1. Relapsing remitting
  2. Secondary progressive
  3. Primary progressive
  4. Progressive relapsing
149
Q

Optic neuritis

A 
Usually unilateral
Acuity 20/100
Onset hours to days
1. Optic nerve pallor
2. Pain w/ EOM

Have 50% chance of developing MS w/in 5 years

150
Q

S/S MS

A
  1. Sensory loss
  2. Optic neuritis
  3. Weakness
  4. Paresthesias
  5. Dysarthria
  6. Dec. pain, vibration & position sense
  7. Ataxia
  8. Horizontal nystagmus
  9. Inc. DTRs, spasticity, Babinski, ankle clonus
151
Q

Dx MS

A
  1. MRI - spotty, irregular demyelination
  2. LP - Oligoclonal bands*
  3. anti-MOG
  4. anti-MBP
152
Q

Tx MS

A
  1. Steroids
  2. Betaseron, Avonex, Rebif, Copaxone
  3. Symptomatic Tx
153
Q

Guillan Barre S/S

A

Progressive symmetrical weakness
Usually from antigen mimicry

Acute inflammatory demyelinating polyradiculoneuropathy mostcommon

  1. Proximal muscle weakness
  2. Legs then arms
  3. Myalgias - shoulder,back, thighs
  4. Paresthesias
  5. Dec. DTRs
154
Q

Common causes of Guillan Barre

A
  1. C. Jejuni
  2. EBV
  3. Mycoplasma
  4. H flu
  5. CMV
  6. VZV
    Vaccinations - H1N1, tetanus, hepatitis
155
Q

Dx & Tx Guillan Barre

A

LP - Inc. protein, EMG

Supportive Tx

156
Q

Chronic idiopathic demyelinating polyneuropathy

A

Chronic form of Guillan Barre
Symptoms >8wks

Dx - LP, EMG, nerve Bx
Tx - steroids, IVIg

157
Q

Myasthenia gravis

A

Neurmuscular autoimmune disease

  1. Proximally asymmetric limb weakness
  2. CN weakness
  3. Lid lag, ptosis, diplopia
  4. Facial weakness, slurred speech
  5. Easy fatigueability

Often get thymoma

158
Q

Dx Myasthenia Gravis

A
  1. ACh receptor Abs
  2. Anti-MuSK
  3. EMG
  4. Tensilon blocks
159
Q

Myasthenia Gravis Tx

A
  1. Mestinon
  2. Immunosuppression
  3. IVIg
  4. Thymectomy
160
Q

Complication of myasthenia gravis

A

Myasthenia crisis

  1. Paralysis of respiratory muscles
  2. Aspiration
161
Q

Risk factors of postherpetic neuralgia

A

Persistent pain in dermatomal distribution

  1. Age
  2. Female
  3. Severe rash, pain at outbreak
  4. Zoster ophthalmicus

Tx pain

162
Q

S/S RSD

A

Relfex Sympathetic Dystrophy

  1. Skin color changes
  2. Temp
  3. Swelling
  4. Tremor/mvmt disorder
  5. Pain
  6. Changes in nail/hair growth

Tx - symptomatic & rehab

Clinical Medicine (11 decks)

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