Neurology #1

Question 1

Tension Headache
-MCC overall of headache
-Describe it
-Treatment

Answer 1

MCC overall of primary headache

Bilateral, pressing, band-like, nonpulsatile steady headache worsens throughout the day. Not worsened with routine activity. No nausea, vomiting, photophobia, phonophobia.

NSAIDs and other analgesics (Acetaminophen, Aspirin) are first-line

Question 2

Cluster Headache
-Triggers
-Symptoms
-More common in…
-Acute Management
-Prophylaxis

Answer 2

-Triggers: ETOH, stress, worse at night
-Severe, unilateral, periorbital or temporal pain (sharp), bouts last < 2 hours with spontaneous remission. Horner’s Syndrome (ptosis, miosis, anhidrosis) ipsilateral, nasal congestion, rhinorrhea, conjunctivitis, lacrimation

-More common in men***
-100% oxygen first-line
-Verapamil as prophylaxis

Question 3

Concussion Syndrome
-Diagnostic of choice for most
-DOC if symptoms > 7-14 days, worsening of symptoms
-Management

Answer 3

-DOC for most: CT head without contrast
-DOC for worsening: MRI
-Cognitive and physical rest, observe for 24 hours, resume activity after symptoms resolve

Question 4

Lower Motor Neuron Injury
-FLABBY

Answer 4

-Fasciculations (involuntary muscle twitches)
-Flaccid Paralysis
-Loss of muscle tone and strength
-Areflexia (decreased DTR)
-Babinski downward (basement)
-Young

-Guillain-Barre, Botulism, Bell Palsy, Cauda Equina (back), Poliomyelitis (baby)

Question 5

Upper Motor Neuron Injury
-SPASTIC

Answer 5

-Slight muscle loss (no atrophy)
-Positive Babinski (toe up)
-Absence of fasciculations
-Strong Tone
-Tone increased
-Increased DTRs
-Clonus

-Stroke, Multiple Sclerosis, Cerebal Palsy, Spinal Cord Damage (TBI)

Question 6

Trigeminal Neuralgia
-MC in…
-In younger patients, suspect…
-What is it?
-Symptoms
-Treatment

Answer 6

-MC in middle-aged women
-In younger patients, suspect MS
-Compression of trigeminal nerve (CNV) by superior cerebellar artery or vein
-Brief, episodic stabbing or shock-like pain in 2nd or 3rd trigeminal division worse with chewing, touch, brushing teeth, wind, movement
-Carbamazepine (first line), Oxcarbazepine

Question 7

Acute Bacterial Meningitis
-25% have a recent history of ____ or _____
-Etiologies
–MCC in adults and children 3 months - 10 years
–MCC in older kids (10-19 years old)
–MCC in neonates < 1 month and < 3 months
–Increased incidence in neonates, > 50 years old, immunocompromised, AIDS, Chemotherapy, etc.

Answer 7

25% have a recent history of otitis or sinusitis

-MCC in adult: Strep Pneumo
-MCC in older kids: Neisseria Meningitidis (may be associated with a petechial rash on trunk, legs, conjunctivae)
-MCC in neonates: Group B Strep (Strep Agalactae)
-Listeria Monocytogenes in older, etc.

Question 8

Acute Bacterial Meningitis
-Symptoms and Exam Findings (2 specific tests)
-Diagnostics
–What is seen?
–When should the one be done first?

Answer 8

-Meningeal symptoms: headache, neck stiffness/nuchal rigidity, photosensitivity, fever
-Positive Brudzinski: neck flexion produces knee/hip flexion
-Positive Kernig: inability to extend the knee/leg with hip flexion
-Diagnostics
–LP + CSF examination: increased opening pressure, turbid appearance, decreased glucose***, increased neutrophils, increased protein
–Head CT scan done prior to LP only if: rule out mass effect, papilledema, seizures, confusion, > 60 years old, immunocompromised, history of CNS disease

Question 9

Acute Bacterial Meningitis
-Management
-ABX
–Empiric for > 1 month - 50 years old:
–Empiric for > 50 (Listeria):
–Empiric for neonates (up to 1 month):

Additional management/precautions

Answer 9

-ABX + Dexamethasone after LP or before head CT if needed.

-Vanco + Ceftriaxone
-Vanco + Ceftriaxone + Ampicillin (Listeria)
-Ampicillin + Gentamicin/Cefotaxime

-Droplet precautions.
-Post-exposure prophylaxis: Cipro or Rifampin x 1 dose