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1Current > (2_3) Neurology in 1 week > Flashcards

(2_3) Neurology in 1 week Flashcards

1
Q

Neurology Overview Map

A

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2
Q

Types of Dementia

A

Dementia (7)

1) Alzheimer’s disease
2) CJD
3) Frontotemporal dementia (Pick’s)
4) Huntington’s disease/Chorea
5) Lewy Body Dementia
6) Normal Pressure Hydrocephalus
7) Wernicke-Korsakoff syndrome

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3
Q

CCS: Dementia workup

A

Labs: BOUPI
CBC with diff
CMP
TFT: TSH/T4
B9 (Folic acid)/B12 (Cobalamin)
VDRL/RPR, HIV

Urine tox screen

Imaging:
CT/MRI brain

MMSE, neuro-psych testing

Donepezil, Olanzapine, Vit. E,
PSAF counseling
(ie Patient/Supportive care/Advance Directive/Family counseling)

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4
Q

CCS: Alcohol withdrawal management

A

1) thiamine then IV D5W NS
2) pyridoxine (B6)
3) folic acid
4) IV diazepam
5) follow K and Mg
6) naltrexone for maintenance therapy
7) addiction unit consult
8) social work consult

Thiamine IM, Lorazepam IV, Folic acid oral, multi-vitamin oral, Chlordiazepoxide oral, Haloperidol IV if agitated, replace phosphate, magnesium, Vit.K IV

Seizure and aspiration precaution, Thiamine, Dextrose, Lorazepam, Vit.K, Folic acid, replace Ph, Mg, and then Chlordiazepoxide, addiction unit consult, Rehabilitation, Anonymous

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5
Q

What are the late manifestations of Alzheimer’s?

A

Apathy and imprecise speech

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6
Q

What is the only abnormality seen on Alzheimer’s workup?

A

CT shows diffuse symmetrical atrophy

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7
Q

How do you treat Alzheimer’s?

A

Galantamine, rivastigmine, donepezil and memantine

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8
Q

What is the mechanism of action of memantine?

A

Blocks NMDA receptor

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9
Q

What are the main features of Pick’s disease?

A

Frontotemporal atrophy
Personality changes before dementia

Treatment same as Alzheimer’s

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10
Q

What is Lewy body dementia?

A

Parkinsonism plus dementia

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11
Q

What is CJD disease?

A

1) Prion is the cause
2) Rapid progressive dementia
3) Myoclonus
4) 14-3-3 protein in CSF
5) Abnormal EEG and no need for biopsy

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12
Q

What are the main features of normal pressure hydrocephalus?

A

WWW:
Wobbly /wide gait (ataxia)
wet ( urinary incontinence)
weird (dementia)

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13
Q

How do you diagnose normal pressure hydrocephalus?

A

CT and LP (normal pressure)

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14
Q

How do you treat normal pressure hydrocephalus?

A

Shunt

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15
Q

CCS: Headache

A

ESR
Temporal artery bx
Depression index

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16
Q

What percentage of migraine is bilateral?

A

40%

17
Q

What is the indication of CT/MRI in headache?

A

>40, sudden severe and neurological deficit

18
Q

What is the treatment for migraine?

A

1) Dark and quiet room
2) analgesics
3) Sumatriptan and ergotamine

19
Q

What is the migraine prophylaxis?

A

If > 3 attacks in a month or severely disabling use beta blockers, calcium channel blockers, tricyclic antidepressants or SSRI

20
Q

CCS: initial management migraine

A

IV NS
IV promethazine, prochlorperazine, metoclopramide
ASA, NSAIDs, acetaminophen
caffeine
IM sumatriptan

Phenergan IV, Sumatriptan IM, prophylactic therapy if >4/ months then give propranolol

21
Q

CCS: long term management migraine

A

prophylaxis- B-blockers- propranolol, metoprolol,
antidepressants- SSRIs, TCAs (amy/nortryptyline)
anticonvulsants-valproic acid, gabapentin
calcium channel blockers-verapamil, nimodipine

22
Q

CCS: Subarachnoid Hemorrhage

A
  1. ESR, CT( lumbar puncture if negative), ketorolac for pain, follow-up q1h, send to ICU
  2. PT/PTT, stool softener (docusate), Neurosurgery consult, Acetaminophen, nimodipine for ischemic stock, labetalol for hypertension, omeprazole, transcranial dler for predicting vasospasm, pneumatic compression stocking, Percoset, iv normal saline for hyponatremia

Orders Pulse oximetry, Blood pressure monitor, Cardiac monitor
Exam General, HEENT, Heart, Lungs, Extremities, Neuro
Orders Head CT without contrast, ECG 12-lead, Oxygen. If indicated:
Suction airway, Intubation endotracheal, Mechanical ventilation.
Clock Advance to results of head CT.
Orders Cerebral angiography, Labetalol, Morphine, CBC, BMP, PT/PTT,
Troponin, ABG, Chest X-ray, Foley catheter, Urine output
Clock Advance to results of cerebral angiography.
Orders Vital signs, Consult neurosurgery
Location Change to ICU.
Clock Advance to additional updates and case end.
End Orders None

Ketorolac IV, Percocet, Docusate, Nimodipine, neurosurgical consult,

23
Q

Neurology Map

A

”


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24
Q

What is the prophylactic treatment for cluster headache?

A

None

25
Q

How do you treat cluster headache?

A

1) 100% 02
2) Steroids
3) Sumatriptan

26
Q

Can cluster headache be bilateral?

A

Never

27
Q

What are the main features of pseudotumor cerebri?

A

Female, headache
Double vision, papilledema, CN VI palsy

CT/MRI normal, LP shows high opening pressure

28
Q

What is the treatment of pseudotumor cerebri?

A

1) Acetazolamide
Weight loss
Steroids
Stop Vit A if the cause

29
Q

What is the one test that generally all patients with vertigo should have?

A

MRI of the auditory canal

30
Q

CCS: AMS

A

Fingerstick glucose
ECG
ABG
CT head wo
UA
Urine Cx
Blood Cx
Ammonia
CBC
B12
Toxicology

AMS of unknown Etiology

  1. Fingerstick glucose
  2. IV Thiamine and Dextrose
  3. Naloxone (narcan)
  4. Urine tox
  5. Blood Alcohol
  6. NPO
  7. CXR to r/o Aspiration
31
Q

Lab Tests to Consider for CCS cases

A

Lab Tests to Consider
*CBC, BMP, and UA is warranted for all patients

*BOUPI
1. Blood: Electrolytes, Vitamin levels, Infxns

CBC, BMP, TFT, LFT, Lipid Panel, PT/INR, PTT
Cultures (for fevers/infection); Type and Screen, Crossmatch
2. Other: EKG, PEFR, Pulse Ox
3. Urine: UA/UC, Urine Tox
4.Pregnancy: urine BHCG
5. Imaging

32
Q

What are the causes of vertigo?

A

1) Benign positional vertigo

2) Vestibular neuronitis
3) Acoustic neuroma
4) Meniere’s disease (tinnitus, vertigo & hearing loss)
5) Perilymph fistula

B-VAMP

33
Q

CCS Case Presentation

A

After noting chief complaint assess the following:

  1. Setting (Office, ED, Ward, ICU)
  2. Demographics: Age, Ethnicity, Gender
  3. Abnormal Vitals: Is patient stable or unstable?
    - Change location as appropriate
    - IVF/access for hypotension
    - Pulse ox and Oxygen for dyspnea/tachypnea
  4. DM?
  5. Allergies
  6. Social Hx: Drugs, ETOH, Tobacco
34
Q

Types of Dizziness/Vertigo

A

Dizziness/Vertigo (6)

1) Acoustic neuroma
2) Benign positional vertigo
3) Labyrinthitis
4) Meniere’s disease
5) Perilymph fistula
6) Vestibular neuritis

35
Q

Types of Headaches

A

Headache (5)

1) Cluster HA
2) Migraine
3) Pseudotumor Cerebri
4) Temporal arteritis
5) Tension HA

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