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EOR - Internal Med > Neurology > Flashcards

Neurology Flashcards

1
Q

possible viral etiology for bells palsy

A

HSV

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2
Q

common preceding event for bells palsy

A

URI

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3
Q

hallmark presentation of bells palsy

A

-sudden onset of unilateral facial weakness/paralysis of upper and lower parts of the face
-unable to wrinke forehad and close one eye

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4
Q

how to differentiate bells palsy from stroke

A

stroke: pt can wrinkle forehad
bells palsy: forehead paralysis

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5
Q

consider _ dz with bells palsy pt’s
do NOT use _ if you suspect lyme dz

A

lyme
steroids

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6
Q

consider _ testing if bells palsy does not resolve w/in 10 days

A

EMG

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7
Q

tx for bells palsy

A

mc self resolves by 1 month
acute: steroids + acyclovir
nighttime eye patch to prevent corneal abrasion
surgical decompression of CN VII if paralysis progresses

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8
Q

47 yo in ED w. stiff neck, photophobia, severe HA that begin while she was gardening - she is in severe distress

A

cerebral aneurysm

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9
Q

pathophys of cerebral aneurysm

A

weak/bulging spot in wall of brain artery

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10
Q

classification of cerebral aneurysm based on diameter

A

small: <15 mm
large: 15-25 mm
giant: 25-50 mm
supergiant: > 50 mm

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11
Q

types of cerebral aneurysm

A

saccular (berry) - mc
fusiform
traumatic
mycotic
ruptured (AVM)

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12
Q

2 mc locations for saccular/berry aneurysms

A
  1. ACA
  2. ICA
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13
Q

mcc of SAH

A

berry aneurysm

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14
Q

dilation of the entire circumference of the BV

A

fusiform aneurysm

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15
Q

what type of cerebral aneurysm is caused by infected emboli

A

mycotic

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16
Q

6 rf for ruptured cerebral aneurysm

A

smoking
HTN
hypercholesterolemia
heavy etoh
polycystic kidney dz
coarctation of aorta

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17
Q

6 sx of ruptured cerebral aneurysm

A

sudden onset worst HA of life
n/v
sz
AMS
HTN
fever

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18
Q

less severe HA that precedes ruptured cerebral aneurysm

A

herald bleed

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19
Q

dx for cerebral aneurysm

A

gs: cerebral angiography
initial: non contrast head CT
LP

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20
Q

2 LP findings of ruptured cerebral aneurysm

A

elevated opening pressure
bloody fluid (xanthochromia) in all tubes

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21
Q

tx for cerebral aneurysm

A

surgical clipping vs endovascular coiling

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22
Q

2 types of CVA

A

ischemic - blockage
hemorrhagic - rupture

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23
Q

mc sx of CVA

A

contralateral paralysis

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24
Q

occular sx of CVA

A

amaurosis fugax (monocular blindness)

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25
Q

4 sx of MCA CVA

A

aphasia
hemiparesis
gaze preference
homonymous hemianopsia

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26
Q

3 sx of ACA CVA

A

leg paresis
hemiplegia
urinary incontinence

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27
Q

hallmark sx of PCA CVA

A

homonymous hemianopsia

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28
Q

5 sx of basilar artery CVA

A

coma
cranial n palsies
apnea
drop attack
vertico

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29
Q

what are lacunar infarcts

A

CVA in areas supplied by small perforating vessels

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30
Q

3 sx of lacunar infarcts

A

pure motor or sensory sx
dysarthria/clumsy hand syndrome
ataxic hemiparesis

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31
Q

3 rf for lacunar stroke

A

atherosclerosis
HTN
DM

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32
Q

initial imaging for CVA

A

CT w.o contrast

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33
Q

management of occlusive CVA’s

A

occlusive: IV tPA w.in 3-4.5 hr of sx onset

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34
Q

indication for endarterectomy

A

carotid a > 70% occluded

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35
Q

absolute contraindications to tPA (9)

A

-hemorrhagic stroke on CT
-hx of ICH
-sx of SAH
-neurosurgery, head trauma, or stroke in past 3 mos
-uncontrolled HTN (SBP > 185, DBP > 110)
-known AVM, neoplasm, or aneurysm
-active internal bleeding
-known bleeding diathesis (PLT<100,000, heparin w.in past 48 hr, elevated aPTT, current antocoags, INR > 1.7)
-BG < 50

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36
Q

45 yo M w. 4 week hx of recurrent nightly 1 hr HA that wake him up during the night - he describes them as a deep excruciating burning sensation centered behind the left eye; he has associated watery eyes/nasal discharge and a sensation of warmth in his face

A

cluster HA

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37
Q

tx for cluster HA

A

100% O2 at 6-12 L/min for 15 min
imitrex

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38
Q

glasgow coma score

A
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39
Q

glasgow coma score < _ = coma

A

9

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40
Q

idiopathic pain syndrome that causes continuous pain disproportionate to the any inciting event

A

complex regional pain syndrome

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41
Q

describe the pain w. complex regional pain syndrome

A

non dermatomal
disproportionate to the injury

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42
Q

budapest criteria for complex regional pain syndrome

A

at least 1 sx in 3/4 four categories:
-sensory: hyperalgesia and/or allodynia
-vasomotor: skin, temp, color, asymmetry
-sudomotor/edema: edema, sweating
-motor/trophic: decreased ROM or motor dysfxn and/or hair/skin/nail changes

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43
Q

tx for complex regional pain syndrome

A

stage 1: gabapentin, amitryptiline, bisphosphonates
stage 2: add steroids
stage 3: consult pain management specialist - regional n block/spinal cord stimulators

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44
Q

transient, traumatic brain dysfxn

A

concussion/mTBI

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45
Q

6 main sx of concussion

A

confusion
memory loss
LOC
HA
dizzy
n/v

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46
Q

clinical definition of concussion/mTBI

A

-glasgow coma score 13-15 30 mins after injury
-conscious loss < 30 min
post traumatic amnesia < 24 hr
-other transient neuro abnl’s

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47
Q

what tool is used to determine if peds should get imaging post mTBI

A

PECARN

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48
Q

management of mTBI

A

-2-3 days of physical/cognitive rest
-return to school 2-3 days post injury
-gradual reintro of activity that does not worsen sx
-return to regular activities when able to do all activities w.o experiencing any sx
-limit caffeine

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49
Q

acute reversible cognitive dysfxn 2/2 to some underlying medical condition

A

delirium

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50
Q

mc type of hallucination associated w. delirium

A

visual

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51
Q

3 rf for delirium

A

post surgery for heart dz
DM
etoh abuse

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52
Q

main diff btw delirium and dementia

A

derlirium is usually reversible

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53
Q

mc presentation of AMS in the inpatient setting

A

delirium

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54
Q

mcc of delirium

A

etoh abuse

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55
Q

delirium caused by acute hyperthyroidism is called

A

thyroid storm

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56
Q

underlying conditions associated w. delirium (7)

A

UTI
PNA
metabolic changes
CVA
MI
TBI
meds

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57
Q

3 meds known to cause delirium

A

anticholinergics
benzos
opioids

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58
Q

workup for delirium should include

A

MMSE/MOCA
B12/folate
LP if febrile

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59
Q

pharm management of acute agitation/psychosis in derlirious pt

A

haldol

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60
Q

long term impaired memory dz that is usually irreversible - represents a marked deterioration from previous level of fxn

A

neurocognitive d.o

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61
Q

2 mc types of neurocognitive d.o

A
  1. alzheimer’s
  2. vascular dz
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62
Q

pathophys of alzheimers

A

beta amyloid plaques
neurofibrillary tangles

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63
Q

pharm management of alzheimer’s

A

anticholinesterase drugs:
tacrine
donepezil

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64
Q

rf for vascular disease

A

arteriosclerotic small vessel dz

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65
Q

vascular dz is mc associated w. a

A

CVA

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66
Q

hallmark presentation of vascular dz

A

-stepwise deterioration w. periods of clinical plateaus
-may involve sudden decline

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67
Q

mainstay of vascular dz management

A

bp control

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68
Q

neurocognitive d.o characterized by language difficulty, personality changes, and behavioral disturbances

A

frontotemporal lobar degeneration

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69
Q

neurocognitive d.o associated w. parkinsonian sx, hallucinations, gait difficulties, and falls

A

lewy body dz

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70
Q

t/f: neurocognitive d.o are rarely associated w. hallucinations

A

t!

if it is, think lewy body dz

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71
Q

neurocognitive d.o associated w. HIV infxn is characterized by

A

memory deficit
impaired executive fxn’ing
poor attention/concentration
apathy

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72
Q

imaging findings of HIV cognitive decline

A

cerebral atrophy

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73
Q

acute inflammation of the brain, often due to bacterial/viral infxn or possibly autoimmune d.o

A

encephalitis

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74
Q

mcc of encephalitis

A

HSV
immunocompromised: CMV

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75
Q

5 sx of encephalitis

A

fever
HA
AMS
sz
exanthema

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76
Q

how is encephalitis differentiated from meningitis

A

altered brain fxn’ing w. encephalitis

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77
Q

work up for encephalitis

A

LP
MRI
PCR

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78
Q

shaking that occurs w. simple tastsk like tying shoes, writing, shaving, or holding hands against gravity

A

essential tremor

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79
Q

2 rf for essential atremor

A

fam hx - autosomal dominant
elderly

80
Q

intention/action tremor mc affects the (2)

A

hands
head

81
Q

essential tremor is aggravated by (4)

A

stress
fatigue
caffeine
temp extremes

82
Q

essential tremor is relieved with

A

etoh

83
Q

tx for essential tremor

A

propranolol
resistant: deep brain stimulation

84
Q

67 yo F w. severe throbbing HA, visual impairment in left eye - pain is worse w. chewing or combing hair - also feels weak/tired - can’t raise arms to reach cabinets - PE shows left sided scalp tenderness, absent left temporal pulse - ESR is elevated

A

giant cell arteritis/temporal arteritis

85
Q

giant cell arteritis causes inflammation of large blood vessels in the (3)

A

scalp
neck
arms

86
Q

4 hallmark sx of giant cell arteritis

A

HA
ttp of scalp
jaw claudication w. chewing
amaurosis fugax

87
Q

what condition is associated w. giant cell arteritis

A

polymyalgia rheumatica

88
Q

gs dx for giant cell arteritis

A

temporal a bx

89
Q

hallmark lab finding of giant cell arteritis

A

ESR > 100

90
Q

tx for giant cell arteritis

A

high dose prednisone asap!
don’t wait for bx results

91
Q

major complication of giant cell arteritis

A

blindness

92
Q

ascending paralysis beginnign in distal limbs and progressing to total paralysis of all 4 limbs, facial muscles, and loss of reflexes

A

guillain barre

93
Q

5 rf for guillain barre

A

post immunization
campylobacter jejuni infxn
CMV
EBV
HIV

94
Q

mcc of guillain barre

A

campylobacter infxn

95
Q

dx for gullain barre

A

LP:
elevated CSF protein
WBC wnl

96
Q

tx for guillain barre

A

plasma exchange
IVIG
PFTs to monitor resp fxn

97
Q

huntington dz is autosomal _

A

dominant

98
Q

hallmark presentation of huntington (4)

A

dementia
mutism
dysphagia
chorea

99
Q

what is chorea

A

nonrepeating, complex, involuntary rhythmic movements that may appear purposeful

100
Q

genetic testing for huntington shows

A

40+ CAG repeats

101
Q

MRI findings of huntington

A

atrophy of cerebrum and caudate nucleus

102
Q

managment of huntington’s

A

chorea: tetrabenzine vs risperidone vs haldol
speech therapy

103
Q

types of intracranial tumors

A

glial
meningioma
vestibular
schwannoma
pituitary adenoma
neurofibroma
CNS lymphoma

104
Q

most _ intracranial tumors are malignant

A

glial

105
Q

3 types of glial intracranial tumors, mc -> lc

A

astrocytoma
ependymoma
medulloblastoma

106
Q

mc type of glial tumor in peds

A

medulloblastoma

107
Q

4 mc sources of intracranial metastasis

A

lung
breast
kidney
GI

108
Q

inflammation of membranes surrounding the brain/spinal cord

A

meningitis

109
Q

meningitis triad

A

HA
fever
nuchal rigidity

110
Q

if meningitis is associated w. a petechial rash, think

A

n. meningitidis

111
Q

mcc of meningitis

A

enteroviruses

112
Q

bacterial causes of meningitis based on pt pop

A

neonate: e.coli, GBS (s.agalactiae)
most people: s. pneumo
immunocompromised: cruptococcus neoformans

113
Q

which type of bacterial meningitis is dx’ed w. india ink stain

A

cryptococcus neoformans

114
Q

cryptococcal meningitis makes you think

A

HIV/immunecompromised

115
Q

LP findings of bacterial vs viral meningitis

A

bacterial: increased pro, decreased glucose
viral: no specific, +/- lymphocytes

116
Q

before performing LP for meningitis, you must

A

CT to check for papilledema

117
Q

tx for meningitis

A

dexamethasone
empirc abx: cephalosporin vs vanco vs pcn
viral: IV acyclovir
household contacts: rifampin vs cipro vs azithromycin vs ceftriaxone

118
Q

hallmark presentation of migraines

A

unilateral, pulsating
nausea
photophobia
phonophobia

119
Q

typical duration of migraine

A

4-72 hr

120
Q

is migraine w. or w.o aura mc

A

w.o aura

121
Q

tx for migraines: abortive vs prophylactic

A

abortive: triptans, ergots
prophylaxis: atenolol/propranolol, verapamil, TCAs

122
Q

contraindication for triptans and ergots

A

triptans: ischemic heart dz
ergots: pregnant

123
Q

21 yo F w. acute onset of double vision in left eye - 2 months ago she had loss of central vision and pupillary light reflex that resolved spontaneously - PE shows delay in adduction of left eye w. nystagmus of right eye on lateral gaze

A

MS

124
Q

AI dz that that causes demyelination and scarring of white matter in brain and spinal cord

A

MS

125
Q

hallmark sx of MS

A

visual disturbances over many years

126
Q

4 mc sx of MS

A

sensory loss
optic neuritis
weakness
paresthesias

127
Q

electrical shock sensation in limbs/torso brought on by flexion of the neck

A

lhermitte’s sign -> MS

128
Q

mc type of MS

A

relapsing-remitting: episodic flare ups over days/weeks btw periods of neuro stability

129
Q

4 types of MS

A

relapsing-remitting
secondary progressive
primary progressive
progressive relapsing

130
Q

MS that relapses, remits, and then progresses to steady decline

A

secondary progressive

131
Q

MS with no episodes of remission - steady decline from onset

A

primary progressive

132
Q

MS that gets worse over time with acute relapses

A

progressive relapsing

133
Q

gs dx for MS

A

MRI showing dawson fingers (white matter lesions)

134
Q

what is this showing

A

dawson fingers -> MS

135
Q

diagnostic criteria for MS

A

2 episodes/attacks
2 different areas of CNS involved

136
Q

CSF findings of MS

A

elevated IgG
oligoclonal bands

137
Q

pharm tx for MS

A

acute: steroids
prevention: interferon betas (avonex)

138
Q

AI attack of Ach receptors at the neuromuscular junction that results in motor problems

A

myasthenia gravis

139
Q

hallmark presentation of MG

A

-fatigability
-weakness in every day activities like brushing hair
-ptosis and diplopia that improves w. rest

140
Q

MG is associated w. _ hyperplasia and _

A

thymic
thymoma

141
Q

dx for MG: initial/mc vs gs

A

initial/mc: tensilon test
gs: SFEMG (single fiber electromyography)

chest CT to r.o thymoma

142
Q

what is the tensilon test

A

injection w. tensilon results in improved muscle strength

143
Q

moa for tensilon

A

prevents breakdown of Ach

144
Q

SFEMG findings of MG

A

decremental response to repetitive stimulation of motor nerves

145
Q

tx for MG

A

-first line: Achase inhibitor: pyridostigmine/neostigmine
-steroids
-thymectomy
-crisis: plasma exchange/IVIG

146
Q

sx of MG crisis

A

neuromuscular respiratory failure
dysphagia/aspiration

147
Q

parkinson’s is caused by degeneration of the _ in the _,
which leads to loss of _ containing neurons

A

degeneration of the basal ganglia
in the substantia nigra
leading to loss of dopamine containing neurons

148
Q

class of meds that causes parkinsonism

A

neuroleptics:
chlorpromazine
metoclopramide
reserpine

149
Q

parkinsinons’ is caused by a _ imbalance

A

Ach/dopamine

150
Q

triad of parkinsons

A

resting/pill rolling tremor
cogwheel rigidity
bradykinesia

151
Q

clinical features of parkinson’s (other than triad)

A

mask facies
loss of postural reflexes
shuffling gait
hypophonia
micrographia
gait arrest
backward falling

152
Q

parkinson’s dx is usually clinical, but what is considered gs

A

neuropathologic exam

153
Q

pharm management of parkinsons

A

<65 yo: dopamine agonists: bromocriptine, pramipexole, ropinirole

> 65 yo: sinemet (levodopa/carbidopa)

154
Q

4 common s.e of sinemet

A

GI upset, n/v
vivid dreams/nightmares
psychosis
dyskinesias

155
Q

typical presentation of peripheral neuropathy

A

symmetrical
stocking and glove distribution

156
Q

pharm managment of peripheral neuropathies

A

gabapentin
amitriptyline
topiramate
tramadol
NSAIDs

157
Q

complication of peripheral neuropathies

A

charcot’s joints

158
Q

2 types of focal sz’s

A

consciousness maintained: simple partial
consciousness impaired

159
Q

presentation of consciousness impaired focal sz (aka complex partial sz)

A

altered consciousness
lip smacking
postictal state: confusion/memory loss

160
Q

how are consciousness impaired partial sz differentiated from abscence sz

A

no postictal state w. absence sz

161
Q

tx for focal sz

A

phenytoin
carbamazepine

162
Q

widespread sz activity in the left and right hemispheres of the brain - start midbrain and spread to both cortices

A

generalized sz

163
Q

6 types of generalized sz

A

absence
tonic-clonic
atonic
clonic
tonic
myoclonic

164
Q

brief impairment in consciousness w. abrupt beginning and end - rarely involve involuntary movements - pt has no recollection

A

absence sz

165
Q

bilat symmetric convulsive sz beginnign w. LOC that involves a post ictal state

A

tonic-clonic

166
Q

3 phases of tonic-clonic sz

A

tonic: stiff/rigid x 10-60 sec
clonic: generalized convulsions/limb jerking
post ictal state: confusion/AMS

167
Q

sz that mimics syncope and involves sudden loss of muscle tone

A

atonic (drop attack)

168
Q

sz characterized by loss of control of bodily fxn, jerking, and post ictal state

A

clonic sz

169
Q

sz characterized by extreme rigidity, immediate LOC, and NO involuntary movements

A

tonic sz

170
Q

sz characterized by muscle jerking, but no loss of muscle tone - mc occurs in the morning

A

myoclonic sz

171
Q

3 types of sz NOS

A

febrile
infantile spasm
psychogenic non-epileptic sz (PNES)

172
Q

3 criteria for febrile sz

A

temp > 38
> 6 mos old, < 5 yo
absence of CNS infxn/inflammation

173
Q

type of epilepsy sz that does not fit into focal or generalized sz

A

infantile spasm

174
Q

PNES sz may mimic

A

epilepsy

175
Q

single epileptic sz lasting > 5 min OR >/= 2 or more sz w.in a 5 min period w.o return to normal in between

A

status epilepticus

176
Q

2 types of status epilepticus

A

convulsive
nonconvulsive

177
Q

convulsive status epilepticus is characterized by

A

regualr pattern of contraction/extension of the arms/legs

178
Q

nonconvulsive status epilepticus includes (2)

A

complex partial status epilepticus
absence status epilepticus

179
Q

pharm for generalized sz, initial vs maintenance

A

initial: lorazepam
maintenance: phenytoin

180
Q

transient LOC/postural tone 2/2 to acute decrease in cerebral blood flow w. rapid recovery of consciousness w.o resuscitation

A

syncope

181
Q

5 types of syncope

A

cardiac
vasovagal
orthostatic
cerebral vascular dz
other noncardiogenic

182
Q

3 causes of cardiac syncope

A

arrhythmias
obstruction of blood flow
massive MI

183
Q

mc type of syncope

A

vasovagal

184
Q

3 rf for orthostatic syncope

A

elderly
DM
meds

185
Q

5 classes of meds that cause orthostatic syncope

A

diuretics
vasodilating ccb
bb
nitrates
antiarrhythmics

186
Q

hallmark presentation of tension HA

A

bilat band like distribution
mild-mod, dull/squeezing pain

187
Q

tension HA pain is:
migraine pain is:

A

tension: bilat, squeezing/dull
migraine: unilateral, pulsating

188
Q

tx for tension HA

A

NSAIDs
muscle relaxants

189
Q

transient episode of neuro dysfxn due to focal brain, retinal, or spinal cord ischemia w.o acute infarction

A

TIA

190
Q

presentation of TIA

A

sudden onset
<60 min (15-30 min avg)
reversal of sx w.in 24 hr

191
Q

4 clinical manifestations of TIA

A

ICA
ICA/MCA/ACA
PCA
vertebrobasilar

192
Q

typical presentation of ICA TIA

A

amaurosis fugax - lampshade down on one eye
weakness of contralateral hand

193
Q

typical presentation of ICA/MCA/ACA TIA

A

sudden HA
speech changes
confusion

194
Q

typical presentation of PCA TIA

A

somatosensory deficit

195
Q

typical presenatation of vertebrobasilar TIA

A

brainstem/cerebral sx -> gait/proprioception deficits

196
Q

pharm management of TIA

A
  1. ASA w.in 24 hr
  2. clopidogrel
  3. high risk: warfarin

EOR - Internal Med (13 decks)

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