neuro pt 1 & 2

Question 1

GCS

Answer 1

best eye opening -
(spontaneously 4, to verbal 3, to pain 2, no response 1)

best verbal
(oriented 5, confused 4, inappropriate words 3, incomprehensible 2, no response 1)

best motor -
(obeys commands 6, withdrawal 5, flexion 4, decorticate 3, extension 2, no response 1)

Question 2

epidural vs subdural imaging

Answer 2

epidural - lentiform like a lemon
subdural - sickle-shaped like a banana

Question 3

imaging recommendations for concussion

Answer 3

GCS <15
focal neurologic deficit
persistent or progressive decline in LOC
seizures
coagulopathy
age >65
skull fracture
persistent headache or vomiting
retrograde amnesia >30 minutes
intoxication
injury to the neck

ED - brain CT imaging of choice
post-traumatic sequelae - brain MRI

Question 4

when to admit for concussion

Answer 4

GCS <15
abnormal CT
seizures
abnormal coags
elderly
intoxicated
soft tissue injury above clavicle

Question 5

ataxia

Answer 5

inability to maintain balance

Question 6

vertigo

Answer 6

sense of the rotational movement of self or surroundings

Question 7

near syncope

Answer 7

a sense of sinking without loss of consciousness

Question 8

syncope

Answer 8

loss of consciousness

cardiovascular!!

Question 9

causes of acquired ataxia

Answer 9

cerebellar insult
ETOH/drug intoxication
infection
metabolic imbalance
malabsorption problems
medications (gabapentin, methotrexate, lithium, amiodarone, cyclosporine)

Question 10

parkinsons patho

Answer 10

imbalance of dopamine and acetylcholine in the basal ganglia and substantial nigra

Question 11

parkinsons diagnosis

Answer 11

clinical diagnosis !!!!!

utilize movement disorder society unified Parkinsons disease rating scale

MRI brain - hypointensity and volume loss of the substantial nigra

Question 12

movement disorder society unified Parkinsons disease rating scale

absolute exclusion criteria (R/O Parkinson’s)

Answer 12

cerebellar signs
supranuclear gaze palsy
established diagnosis of BVFTD
Parkinsonism restricted to the lower limbs only for >3 years
treatment with anti dopamine agents
absence of response to levodopa
sensory-cortical loss
no evidence of dopaminergic deficiency on functional imaging
other Parkinsonism-inducing condition

Question 13

parkinsons s/s

Answer 13

fatigue
constipation
depression
hypomimia (parkinsonian mask)
shuffling gait
impaired swallowing
rigidity
bradykinesia
tremor
postural instability

Question 14

parkinsons treatment

Answer 14

symptom modification

PT, OT, SLP

deep brain stimulation

levodopa - first line (if works, confirms dx), take multiple x/day

2nd line - dopamine agonists

Question 15

dementia DSM criteria

Answer 15

cognitive impairment: learning and memory, language, executive function, complex attention, perceptual-motor function, or social cognition

cognitive deficits interfere with IADLs

no delirium

no other mental disorder that better explains cognitive decline

Question 16

dementia RF

Answer 16

age
genetics
female>male
mild cognitive impairment
vascular disease
lifestyle & activity

alzheimer’s - Down syndrome

Question 17

dementia diagnostics

Answer 17

CT/MRI brain for initial evaluation - generalized/focal atrophy and white matter lesions

R/O other causes - syphilis, HIV, B12, thyroid, etc

functional assessment staging tool (FAST) for prognostication

Question 18

cholinesterase inhibitors

Answer 18

first line for Alzheimer’s and Lewy body dementia

treat cognitive symptoms

Question 19

dementia meds

Answer 19

treat symptoms!

cholinesterase inhibitors - first line
NDMA receptor antagonist (Memantine)
SSRI - prevent anxiety/agitation
antipsychotics - PRN for agitation
benzodiazepines - PRN

Question 20

Alzheimer’s symptoms

Answer 20

insidious onset memory loss
progresses to frustration, personality changes, dysphagia, conversation inability

duration 8-10 years

Question 21

vascular dementia classic presentation

Answer 21

multi-infarct dementia , often mixed w Alzheimer’s

stepwise pattern of progressive cognitive decline following each vascular event

no improvement after each CVA

executive function decline more prominent than memory loss

Question 22

vascular dementia diagnosis and treatment

Answer 22

stroke s/s

brain CT/MRI - multiple infarcts

prevent new ischemic injury - aspirin, plavix, anti-coagulants, lifestyle modifications

Question 23

frontotemporal dementia

Answer 23

“picks disease”
behavioral symptoms in early stages
autosomal dominant

preserved memory, behavioral/personality/emotional symptoms predominant

ex. gambling, impulsiveness, sexual activities, aggressive verbal/physically

tx w SSRIs/BDZ/antipsych for behavior symptoms

Question 24

parkinson’s dementia

Answer 24

RF: advanced age and severity of parkinsons

executive dysfunction, inattention, motor impairment affects language, hallucinations, paranoia

tx: manage motor symptoms, cholinesterase inhibitors, memantine

Question 24

Lewy body dementia

Answer 24

early psychosis, visual hallucinations, sleep disorders and parkinsonian-like movements

marked fluctuation in cognitive functioning on daily basis

tx: cholinesterase inhibitors, memantine, parkinsons meds, SSRIs/atypical antipsychotics, nonpharm behavior modifications