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NS2 Test 3 > Hon--Headache, MS, Stroke, Seizures > Flashcards

Hon--Headache, MS, Stroke, Seizures Flashcards

1
Q

Headache–associated symptoms

A
  • nausea
  • vomiting
  • anorexia
  • photophobia
  • phonophobia
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2
Q

headache triggers

A
  • hormones
  • diet
  • stress
  • environmental changes
  • sensory stimuli
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3
Q

worrisome signs (NOT benign headache)

A
  • worst HA
  • onset of HA after age 50
  • atypical HA for patient
  • fever
  • progressive worsening
  • drowsiness, confusion, memory impairment
  • weakness, ataxia, loss of coordination
  • paresthesias
  • abnormal medial/neuro exam
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4
Q

any patient with worrisome history or abnormal exam needs what?

A
  • CT

- if nothing there–do LP! (CT can miss 10% of subarachnoid hemorrhages)

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5
Q

common migraine

A
  • moderate to severe
  • no aura
  • 35-40 years, female
  • 1-4 per month
  • 12-24 hours duration
  • throbbing, sharp, pressure
  • prodrome
  • postdrome
  • retreat to dark, quiet room
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6
Q

classic migraine

A
  • aura
  • 15-30 min
  • commonly visual symptoms
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7
Q

tension type HA

A
  • mild to moderate
  • doesnt prohibit daily activities
  • 20-40 years
  • females
  • episodic 15 days/month, all day, waxing, waning
  • bifrontal, bioccipital
  • dull aching
  • no prodrome or aura
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8
Q

cluster HA

A
  • severe, excruciating
  • prohibits daily activities
  • 20-50s, males
  • associated with obstructive sleep apnea
  • episodic–1 or more attacks/day for 6 weeks
  • chronic–several attacks per week
  • 30 min to 2 hours
  • 100% unilateral! orbitotemporal
  • no aura
  • pacing, rocking, frenetic
  • ptosis, miosis, conjunctival infection, lacrimation, stuffed or runny nose
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9
Q

preventative treatment for chronic migraine?

A

BOTOX injections (effective 80-90%)

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10
Q

paroxysmal hemicrania–what is it? treatment?

A
  • indomethacin

- similar to cluster headache, but shorter in duration (only minutes)>5 times a day

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11
Q

MS definition

A
  • exacerbations and remissions

- loss of myelin

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12
Q

MS symptoms

A
  • paresthesias
  • gait disturbances (transverse myelitis)
  • weakness
  • visual loss
  • urinary difficulty
  • dysarthria
  • hemiparesis
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13
Q

4 types of MS

A
  • relapsing remitting (50%)
  • secondary progressive (25%)
  • primary progressive (15%)
  • benign (10%)
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14
Q

MS onset, cause, affects who

A
  • 20-30 years of age
  • cause unknown, some genetic susceptibility, illness that sensitizes the immune system to attack CNS myelin?
  • women, in temporate zones
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15
Q

MS diagnosis

A
  • MRI lesions in periventricular white matter
  • LP-oligoclonal bands, IgG
  • multiple lesions over space and time
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16
Q

drugs for MS maintenance

A

(decrease frequency and severity of exacerbations and slow progression of disease)

  • Avonex, Rebif (interferon beta)
  • Betaseron (interferon beta)
  • Copaxone (Glatirimer acetate)
  • betaseron only approved for chronic progressive MS
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17
Q

MS drugs to treat acute exacerbation

A
  • corticosteorids (solumderol, prednisone taper)

- reduces length of exacerbation

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18
Q

MS different from ADEM how?

A

-ADEM never recurs!-post infectious or post immunization encephalomyelopathy

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19
Q

other DDs for MS

A
  • ADEM
  • autoimmune disease (SLE, CNS vasculitis, polyarteritis nodosa)
  • B12 deficiency
  • lymphoma or leukemia
  • spinocerebellar ataxias
  • vascular malformations (AVM)
  • infections (HIV, syphilis)
  • granulomatous disease (sarcoidosis)
  • metachromatic leukodystrophy, adrenomyeloleukodystrophy
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20
Q

treat symptoms of MS spasticity

A

-Baclofen, tizanadine, diazepam, carbamazepine, Botox, dantrolene

21
Q

treat symptoms of MS-intention tremor

A

-propranolol, primidone, clonazepam

22
Q

treat symptoms of MS–urinary urgency

A

-oxybutinin

23
Q

treat symptoms of MS–urinary retention

A

bethanechol

24
Q

treat symptoms of MS–painful dysesthesias

A

-carbamazepine, gapapentin, phenytoin, baclofen

25
Q

treat symptoms of MS–fatigue

A

-amantadine, modafinil, fluoxitine

26
Q

risk factors for stroke

A
  • age
  • previous TIA or stroke
  • atherosclerosis
  • cardiac disorders (valvular heart disease, atrial fibrillation, mural thrombus, endocarditis, atrial myxoma, interatrial septal abnormalities)
  • drug abuse
  • oral contraceptives
  • pregnancy
  • fibromuscular dysplasia
  • hypercoagulable states
  • infl disorders
27
Q

treatment for stroke

A

-ABCs
-dont treat acute hypertension
-dont give IV glucose
neuro exam
-labs–CBC, PT, PTT, chemistry panel, glucose, UA, X ray
-treat fever
-elevate HOB 30 degrees

28
Q

NIH stroke scale

A

-score 20–18% risk of hemorrhage

29
Q

what looks like stroke?

A
  • seizure
  • migraine
  • hypoglycemia
30
Q

when do you use tPA

A
  • within 3 hours of onset of symptoms
  • no stoke or head trauma in 3 months
  • no major surgery in 2 weeks
  • no intracranial hemorrhage
31
Q

when is warfarin indicated?

A
  • atrial fibrillation
  • prosthetic valve
  • MI
  • atrial septal defect
  • hypercoaguable state
  • large vessel disease
32
Q

epilepsy defined as

A

2 or more unprovoked seizures

33
Q

% positive findings on 1 EEG

A
  • 90% for petit mal (absence)

- 40% for all types

34
Q

85% positive finding for epilepsy when?

A

3 sleep deprived EEG

35
Q

important to diagnosis for epilepsy?

A

history–witness!

36
Q

partial seizures

A
  • simple partial
  • complex partial
  • secondarily generalized (partial onset)
37
Q

Generalized seizures

A
  • absence (petit mal)
  • tonic clonic
  • myoclonic
  • tonic
  • clonic
  • atonic
38
Q

simple partial seizures

A
  • focal motor or sensory activity
  • no LOC
  • lasts seconds
  • no post ictal state
39
Q

complex partial

A
  • nonresponsive staring
  • possible aura
  • automatisms (pick at clothes, lip smacking, chewing)
  • LOC
  • 1-3 min
  • post-ictal state
40
Q

secondary generalized

A
  • b/l tonic-clonic activity
  • LOC
  • -1-3 min
  • post ictal state
41
Q

absence (petit mal)

A
  • nonresponsive staring
  • rapid blinking, chewing, clonic hand motions
  • LOC
  • 10-30 sec
  • no post ictal state
42
Q

tonic-clonic

A
  • b/l extension followed by symmetrical jerking of extremities
  • LOC
  • 1-3 min
  • post ictal state
43
Q

myoclonic

A
  • brief rapid jerking of extremities
  • LOC
  • lasts few seconds
  • minimal post ictal state
44
Q

drug for absence only

A

ethosuxamide

45
Q

drugs used for primary generalized and partial

A
  • valproate
  • lamotrigine
  • leviteracetam
46
Q

status epilepticus treatment

A
  • benzodiazepam (lorazepam)

- fosphenytoin

47
Q

women with epilepsy drugs; avoid? use?

A

avoid valproic acid

use newer drugs–lamotrigine, leviteracetam

48
Q

syncope

A
  • pallor, sweating
  • lightheadedness
  • slow onset
  • positionally related
  • brief unconsciousness
49
Q

seizure

A
  • urinary/bowel incontinence
  • tongue injury
  • tonic/clonic movements
  • post ictal state

NS2 Test 3 (14 decks)

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