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FNP Review > Neurological > Flashcards

Neurological Flashcards

1
Q

Tension headache characteristics

A

Pressing, NON-PULSATING pain
Mild to moderate intensity
Usually BILATERAL location
0-1 following: nausea, photophobia, photophobia

Female:Male= 5:4

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2
Q

Migraine w/out aura characteristics

A

Lasts 4-72 hours with >2:
Usually UNILATERAL location, occasionally bilateral
PULSATING quality
Moderate to severe intensity
AGGRAVATED by normal activities
>1: nausea, vomiting, photophobia, phonophobia

Female:Male= 3:1

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3
Q

Migraine with aura characteristics

A

H/A occurs with or after aura
Feelings of Dread, ANXIETY, unusual fatigue, nervousness or excitement.
Positive family hx in 70-90%

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4
Q

Cluster headache characteristics

A

Often located BEHIND EYE with a steady, intense “HOT POKER IN THE EYE” intensity. Lasting 15min to 3 hours with most in the range of 30-45 min.
Ipsilateral autonomic signs such as lacramation, conjunctival injection, ptosis, & nasal stuffiness.
Female:Male= ~1:3 or 1:8

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5
Q

Examples of primary headaches

A

Migraine (with or w/out aura), tension headache, cluster headache

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6
Q

Causes of secondary headaches

A

Tumor, intracranial bleeding, increased ICP, medications (nitrates), meningitis, accelerated HTN, giant cell arteritis, or viremia.

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7
Q

Red flags with headaches

A

Systemic symptoms- fever, wt loss, ect.
Neuro sx- confusion, nuchal rigidity, papilledema, cranial nerve dysfunction, or abnormal motor function.
Sudden onset, “thunderclap”, headache with exertion, sexual activity, coughing, sneezing.
Age of onset >50 or

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8
Q

Sx of increased ICP

A

H/A, nausea/vomiting, increased BP, confusion to time, location, person, double vision, pupils interactive to light.

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9
Q

Medications for migraines

A

Triptans (selective serotonin receptor agonists), ex- sumatriptan Imitrex
Selected ergot derivatives ex- dihydroergotamine Migranal

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10
Q

Prophylactic medications for migraines

A

Beta-blockers: metoprolol, propranolol
Tricyclic antidepressants: amitriptyline, nortriptyline
Antiepileptic drugs: divalproex sodium (Depakote), sodium valproate (Depacon), topiramate (Topamax)
Supplements: butterbur, feverfew, coenzyme Q10, mag, riboflavin
Lithium (cluster headaches)
CCB: verapamil

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11
Q

Classic triad for Giant cell arteritis

A

Fever, normal WBC count, increased sed rate.

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12
Q

Giant cell arteritis etiology

A

Autoimmune vasculitis that affects medium & large-sized vessels as well as the temporal artery.
Inflammation & swelling of the arteries leads to decreased blood flow & its associated symptoms.

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13
Q

Treatment of giant cell arteritis

A

Tx aimed to reduce pain & minimize risk of blindness.

High-dose corticosteroids (1-2mg/kg per day prednisone until disease is stabilized). Continue lower dose 6mths-2 years.
ASA to reduce stroke risk.
PPI for GI cytoprotection.
Biphosphonate for bone protection.

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14
Q

Dietary triggers for migraines

A

Sour cream, pickled, fermented foods, MSG, yeast products, onions, citrus fruits, caffeine, ETOH, aspartame.

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15
Q

Kernigs sign

A

Flexing pt’s hip 90 degrees, then extending the pts knee-leads to meningeal pain.

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16
Q

Brudzinskis sign

A

Flex ion of the pts neck causes flexion (involuntary) of pts hips & knees. Meningeal pain.

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17
Q

Bell’s palsy definition

A

Paralysis or weakness of the muscles on one side of the face. Damage to the facial nerve that controls muscles on one side of the face that causes that side of the face to droop.
CRANIAL NERVE 7 dysfunction.
* most cases thought to be caused by the herpes virus that causes cold sores.

18
Q

Trigeminal neuralgia definition

A

Chronic pain condition that affects the trigeminal or 5th CRANIAL NERVE.
Causes extreme sporadic, sudden burning or shock-like facial pain that lasts a few seconds to 2 minutes per episode.

19
Q

CVA management in primary care

A

ASA 81mg (325mg if previous CVA), ASA/dipyridamole (Aggrenox) po BID, clopidogrel (Plavix) 75mg qd.

20
Q

Dizziness etiology

A

Peripheral- inner ear condition (most common)

Central- brain stem

21
Q

Red flags with dizziness

A

Neuro deficits, severe H/A, nausea, central nystagmus, or concern for mass/structural lesion.

22
Q

Differential dx for dizziness w/ tx

A
  1. Benign paroxysmal positional vertigo BPPV. Tx: repositioning maneuvers, Eply maneuver.
  2. Ménière’s disease. Tx: supportive, meclizine, scopolamine, promethazine, salt restriction.
  3. Acute vestibular neuropathy (viral cause). Tx: supportive, improved sx with steroids- full recovery can take several weeks.
23
Q

Multiple sclerosis definition

A

Chronic, debilitating neurological disease due to an autoimmune process.
Characterized by formation of patches of demyelination (plaques) throughout the brain & spinal cord.
Higher prevalence in Caucasians & women.

24
Q

Sx of multiple sclerosis

A

Visual symptoms, possible trigeminal neuralgia, limb weakness, easy fatigability, dysarthria, in coordination of limbs, paresthesias, attention deficits.
Lhermitte’s sign- electric shock-like sensations that run down the back and/or limbs upon flexion of the neck.
Uhtoff’s phenomenon- heat intolerance

25
Q

Common presentation of Parkinson’s disease

A

Stiff or weak limb, tremor, asymmetric slowness, shuffling gait, reduced arm swing.
* diagnosis is CLINICAL based on the history & physical exam findings. Conventional imaging studies not helpful.

26
Q

Management of Parkinson’s disease

A

Levodopa- biochemical precursor of deficient NT dopamine ( most common tx)
Dopamine agonists- mirapex & requip
Anticholinergic agents- trihexyphenidyl (Artane) & bentropine (Cogentin)

27
Q

Myasthenia Gravis definition

A

Autoimmune disorder that affects the neuromuscular junction.
Characterized by fluctuating, fatigable weakness of muscles under voluntary control.

28
Q

Management of myasthenia Gravis

A

1st line- Acetylcholinesterase inhibitors (Mestinon- pyridostigmine bromide.
Immunosuppressive tx- steroids, azathioprine, cyclosporine.
Plasmapheresis
IVIG

29
Q

CN III function

A

Oculomotor

Pupillary constriction, opening eye (lid elevation), most extra-ocular movements- looking up/down

30
Q

CN IV function

A

Trochlear

Downward, internal rotation of the eye, looks downward & laterally

31
Q

CN V function

A

Trigeminal
Motor- temporal & masseter muscles (jaw clenching), lateral pterygoids (lateral jaw movement)
Sensory- 3 divisions= ophthalmic, maxillary, mandibular.
corneal reflex

32
Q

CN VI function

A

Abducens

Lateral deviation of the eye, looks left/right

33
Q

CN VII function

A

Facial
Motor- facial mvmts, facial expressions, closing eye, closing the mouth.
Sensory- taste sweet, salty, sour, bitter on anterior 2/3 of tongue.

34
Q

CN VIII function

A

Acoustic

Hearing (cochlear division), balance (vestibular division)

35
Q

CN IX function

A

Glossopharyngeal
Motor-pharynx
Sensory- posterior portion of the eardrum & ear canal, the pharynx & posterior tongue, including taste.

36
Q

CN X function

A

Vagus
Motor- palate, pharynx/larynx
Sensory- pharynx/larynx

37
Q

CN XI function

A

Spinal accessory

Motor- sternomastoid & upper portion of trapezius

38
Q

CN XII function

A

Hypoglossal

Motor- tongue

39
Q

Alzheimer’s disease patho

A

Neuritic plaques, neurofibrillary tangles

40
Q

Alzheimer’s management

A

Mild to moderate- 1st line Cholinesterase inhibitors= donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl).

Moderate to severe- add Namenda

41
Q

Restless leg syndrome definition & sx?

A

Neuro sensorimotor disorder, characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations.

Sx- worse at night, relieved by movement, worse at rest-bilateral (can also affect the arms).

42
Q

Treatment of RLS?

A
  • Dopaminergic agents- Requip, Mirapex
  • Alpha2 delta calcium channel ligands- Gabapentin, Lyrica
  • Opioids- oxycodone, codeine, methadone, tramadol
  • Benzodiazepines- clonazepam

FNP Review (15 decks)

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