Week 2 Flashcards
signs of benzo OD
CNS depression, ataxia, normal vitals, slurred speech
if a patient has relavent afferent pupillary defect what is the injury
optic nerve injury
what is the management for microcephaly and what is considered microcephaly?
<3rd percentile is microcephaly and you do an MRI
what is memantine
it is a NMDA receptor antagonist used in severe dementia
describe cauda equina syndrome
this is where you have a severe disc herniation and the disc compresses the cauda equina. you have bowel and bladder sx, saddle anesthesia, radicular pain, and asymmetric paresis of the legs, only peripheral nerves so no UMN symptoms
describe conus medularis syndrome
conus medularis syndrome is when the disc herniates and compresses the conus medularis (T12-L2). the pain is sudden and bilateral, you have spastic hyper-reflexic paralysis (bc whole spinal cord)
describe friedrich ataxia: how it presents and inheritance
disorder of the frataxin protein that causes onset of gait ataxia, and slowly progressing limb paralysis. Other signs are upgoing toes, scoliosis, diabetes, and cardiomyopathy. it is autosomal recessive and a triculeotide repeat mutation
describe autoimmune encephalitis
auto Ab against NMDA receptors which causes psychiatric symptoms, autonomic instability (HTN, hyperthermia, tachy), cognitive impairment, rigidity, dystonia, and focal seizures following flu-like illness
what is strongly associated with autoimmune encephalitis
ovarian teratoma
differentiate between cluster, tension, and migraine headaches
cluster: unilateral, autonomic sx, at night, trt oxygen // tension: bilateral, nopulsatile trt NSAIDS // migraine: unilateral, pulsatile, must have nausea or photophobia or aura abort with triptan
what does loss of grey-white matter differentiate mean on noncontrast-CT
this means ischemic changes and often don’t show right away
describe different presentations of parkinsons
can be mostly bulbar symtoms without tremor, ie soft voices, aspiration and eating difficulty, loss of olfactory ability, rigidity of upper limbs, and stooped posture
describe presentation and what can cause wernicke encephalopathy
presentation: nystagmus, bilateral abducens palsy, postural and gait ataxia, encephalopathy. can be due to thiamine deficiency from alcohol use or malnutrition
presentation of cryptococcal infection in HIV impatients
increased ICP, headaches, nausea/vomiting, confusion, scattered skin papules,
describe physiologic tremor
bilateral tremor that is not caused by an underlying disorder. worsened by stress, caffeine, illness, etc.
do you give a patient with endocarditis antiplatelet therapy
NO! this increases the risk of hemorrhagic conversion for them so you dont want to do that
signs of deliriuem tremens
confusion, tremulousness, symptathetic overdrive (diaphoresis, high bp etc. ), hyperreflexia occurs 2-5 days post last drink
differentiate between Imaging findings in a patient with neurocystercosis vs. coccidiodes meningitis
neurocystercosis will have a ring enchancing lesion presents with seizures. Coccidiodes meningitis is more typical meningitis findings but is more slowly progressive
describe neuromyelitis optica and how to dx it
this is when you have intense inflammaiton and demyelination of different spinal cord segments AND the optic nerve I.e. vision loss and asymmetrical weakness. also episodes of hiccups Dx by aquaporin-4 Ab
describe where/presentation of meningiomas vs. glioblastomas are
meningiomas are often in the parasaggital sinus, so you would get leg weakness and normally present with seizures // glioblastomas are often across the corpus callosum and present similarly but more acute/intensely
what do you do for hypertensive encephalopathy and describe what this looks like
super high bp, tachycardia, tonic-clonic seizures, papilledema // give nitroprusside
are lacunar infarcts transient
NO! they will still show theyre reg symptoms
if a patient has occulomotor nerve palsy and they have signs of SAH, where was their aneurysm
it would be in the posterior communicating arter, anterior cerebral / anterior ocmmunicating connection is the most common still but this would be bitemporal hemianopsia
describe findings of cervical spondylotic myelopathy
lower motor neuron signs in the arms and neck pain with movement. but lower motor neuron signs below the lesion, degeneration of the facet joints, vertebral bodies, or herniated discs
signs of acute cerebellar dysfunction in a child and what dx tests to do
inability to walk, nystagmus, dysarthria, speech abnormalities, etc. get a stat CT
signs of diaphragmatic paralysis in an ALS patient
more shortness of breath while supine
can huntingtons patients suppress their chorea early on
yes!
how do you manage NPH
you can do a lumbar punture to assess for elevated opening pressure
what is a normal ESR
a normal value is <20
when is the straight leg raise positive and what does it mean
it is positive when pain radiates down the leg, it means there is something compressing the nerve root
what do healthcare workers need to wear when working on a patient with organophosphate poisoning
rubber gloves
what is sleep paralysis and what is the treatment
sleep paralysis is when you cannot move after waking up because of the tranistion from REM to wakefulness, it happens more often with stress and substance use and poor sleep. no treatment unless it happens a lot
what does cerebral toxo infection look like
several ring enhancing lesions, seizures, lesions are in the brainstem, corticomedullary junction, basal ganglia and pituitary
where is the infarct if there is a pure sensory stroke
the thalamus!
how do you treat an aneurysm rupture
surgical clipping
what is first line treatment of open angle glaucoma
latanoprost
what are signs of open angle gIaucoma?
optic disc cupping, headaches, blurry vision, negative goinoscopy exam (primary test for CLOSE angle glaucoma)
what are the hallmarks of tuberous sclerosis tumor wise
RCC, subepyndymal giant cell astrocytoma, angiomyolipomas of the kidney, ungual (under nails) fibromas, cardiac rhabdomyomas, cerebral hamartomas
cutaneous signs of tuberous sclerosis
angiofibromas of the face, shagreen patches, ash-leaf spots
other signs (non tumor non cutaneous) of tuberous sclerosis
intellectual disability, seizures
Hallmarks of NF1
optic gliomas, pheos, multiple neurofibromas, lisch nodules (in the eye), many a cafe-au-lait spot
Hallmarks of NF2
skin schwannomas, bilateral acoustic neuromas, meningiomas, spinal ependymomas
signs of cerebral toxo infection
fever, headache, low CD4 count, HIV+, seizures, focal neurological deficits, multiple ring enhanching lesions in the basal ganglia
signs of PML
multiple white matter non ring lesions, seizures, impaired attention, focal neurological signs, reactivation of JC virus
signs of primary CNS lymphoma
focal neuro signs, personality changes, headache, solitary ring enhancing lesion
signs of cerebral abscess
solitary ring enhancing lesion, signs of elevated ICP (papilledema, altered mental status, positional headache etc. ), elevated WBCs and ESR, focal neuro deficits, fever, etc.
signs of cryptococcal meningitis
subacute meningitis (i.e. signs but has been slowly progressive over weeks), high protein, low glucose, lymphocytic predominance, fever malaise headache, elevated ICP
