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my clin med 4 > Neuro > Flashcards

Neuro Flashcards

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1
Q

Types of primary headache (3)

A

Migraine
Tension type
Cluster

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2
Q

Typical quality of migraine

A

pulsating, throbbing, lateral,

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3
Q

Typical quality of tension head ache

A

tightness, pressure, band like, worse at end of day

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4
Q

cluster headache quality

A

Ice pick, same time each day or night

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5
Q

Additional symptoms of migraine (4)

A

N/V, photophobia, sound and smell sensitivity

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6
Q

treatment of tension headaches

A

treat anxiety and depression, CBT, relaxation, Massage

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7
Q

Number of migraines to be diagnostic recurrent:
without aura
with aura

A

without aura: 5

with aura: 2

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8
Q

migraine Treatment (non- pharmacologic)

A

avoid precipitating factors,
rest in quiet dark room,
simple ananglesic

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9
Q

Pharm treatment of migraine

A 
Ergotamines - cafergot
Sumatriptan 
prochlorperazine (Compazine)
Reglan or Zofran 
Butalbital - habit forming
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10
Q

migraine preventative therapy - when indicated and what

A

if migraines >2-3 x per month
botulism,
acupuncture, neurostimulation techniques

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11
Q

cluster headache number for diagnosis

A

5 attacks occurring everyother day - 8x / day

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12
Q

prophylactic cluster headaches treatment (3)

A

lithium carbonate
verapamil
topiramate

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13
Q

pseudotumor cerebri symptoms (4)

A

papilledema,
increased ICP,
normal or small ventricle sizes.
Diplopia, blurred vision, transient visual obscuration

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14
Q

Pseudotumor cerebri treatment

A

repeat LP, Acetazolamide
thiazide diuretics,
steroids

Severe: lumbar peritoneal shunting, optic nerve sheath decompression

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15
Q

Post herpetic neuralgia treatment

A

anticonvulsants, gabapentin, antispasmodic agents,

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16
Q

Myasthenia gravis Signs and symptoms

A

extra ocular muscle and skeletal muscles weakness and fatigability d/t decrease in Ach receptors in neuro muscular junction
exacerbations and remissions (non-complete)
non-symmetric proximal muscle weakness

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17
Q

Myasthenia Gravis treatment

A

acetylcholine esterase inhibitor (pyridostygmine) –>
prednisolone and azathioprine –>
mycophenolate mofetil –>
other immune suppressive drugs

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18
Q

Cerebral Palsy definition and cause

A

chronic static impairment of muscle tone, strength, coordination and movement
caused by cerebral insult at birth

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19
Q

Tourette’s syndrome onset and resolution

A

mean onset age 5

Resolves by adulthood usually

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20
Q

tourettes symptoms and sleep

A

DO NOT disappear with sleep,

awake Pt may be able to suppress or camouflage tics

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21
Q

necessary length of vocal or motor tics for tourettes diagnosis

A

1 year

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22
Q

tourettes treatment

A

usually no treatment - CBT is best
neuroleptics - suppress tics
alpha adrenergic agonists - clonidine, guanfacine
DNU - ADHD drugs with Tourette’s - BBW!!

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23
Q

MS definition

A

destruction of myelin sheaths

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24
Q

MS symptoms (12)

A 
fatigue, 
depression,
 memory changes,
 pain,
 spasticity,
 vertigo, 
tremor,
 double vision or vision loss,
 weakness, 
dizziness, 
numbness,
ataxia
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25
Q

MS diagnostic feature

A

Must have at least 2 episodes of symptoms that result from involvement of different areas of the CNS

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26
Q

MS treatment

A

interferon Beta 1- suppresses immune system
Glatiramer acetate - more SE,
Mitoxantrone - Cardio toxic
Steroids - for acute attacks

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27
Q

Guillain barre cause

A

caused by infection or inocculation

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28
Q

Meningitis causes

A

usually bacterial

or viral

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29
Q

Meningitis cardinal symptoms (4)

Bonus (5)

A 
HA, 
Fever, 
neck stiffness, 
altered mental status
Bonus (N/V, Photophobia, focal neuro deficit, seizures, rash [non-blanching])
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30
Q

Bacteria of meningitis

A

Strep Pneumo (kids and adults)
H. flu (adults)
N. Meningitidis (kids)

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31
Q

Aseptic meningitis - different from Bacterial

A

Spring and fall onset
Caregivers - fecal-oral
benign course resolves on own

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32
Q

Meningitis Diagnosis

A

Lumbar puncture (may need head CT first)

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33
Q

Meningitis -req. Head CT criteria

A 
altered Mental status, 
seizure w/in 1 week of presentation, 
Known CNS lesion or disease, 
focal neuro finding
papilledema
>60
immunocompromised
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34
Q

Bacterial meningitis tx

A

Antibiotics AND STEROIDS - if LP is delayed for any reason, Abx first then delay (sterilization may occur within 2-4 hours so get LP ASAP)
antivirals if any suspicion,
If elevated ICP - mannitol, neuro consult

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35
Q

LP with 100-5000 WBC, Decreased glucose and elevated protein

A

Bacterial meningitis

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36
Q

LP with 10-500 WBC, normal glucose and elevated protein

A

Viral meningitis

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37
Q

LP with 0-500 WBC, Decreased or normal glucose and elevated protein

A

Fungal meningitis

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38
Q

Encephalitis symptoms

A

fever, HA, altered mental status, may be accompanied by seizures or Focal neuro deficit
(May have meningitis too - meningoencephalitis)

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39
Q

Encephalitis - West nile treatment

A

supportive

40
Q

Encephalitis - paraneoplastic & auto immune - treatment

A

IV IG
IV Steroids
resect tumor if applicable

41
Q

Encephalitis risk factors

A

children or elderly
Immunocompromised,
Summer/ early fall

42
Q

General encephalitis treatment

A

Acyclovir IV

If seizures - Benzos and Anticonvusants

43
Q

Intracranial epidural abscess - treatment

A

craniotomy

Vanco +3rd or 4th cephalosporin

44
Q

Spinal Epidural abscess

A

early decompression/ debridement,
Antibiotics - Vanco +3rd or 4th cephalosporin
4-6 weeks

45
Q

Parkinsonism definition

A

bradykinesia, with rigidity and tremor

46
Q

Parkinson’s disease symptoms

A

Bradykinesia,
One of: resting tremors, muscular rigidity, postural instability
dysautonomia causing supine HTN with orthostatic hypotension, dementia, voice and speech disorders,
depression, psychosis

47
Q

Parkinson’s treatment

A

Levodopa, w/ dopa decarboxylase inhibitor

48
Q

Drugs that induce parkinsonism

A

Bilateral symptoms Haloperidol,

thioridazine, periphenazine, anti-emetic

49
Q

Huntington’s disease - cause

A

genetic disorder

50
Q

Huntington’s symptoms

A

incoordination, abnormal movement and intellectual decline,
chorea- brisk rhythmic movement,
gait disturbances, dysarthria and dysphagia, Depression, OCD

51
Q

Essential tremor - age of onset

A

45

52
Q

Essential tremor - diagnosis

A

tremor with fine motor in hands and forearms,
head tremor with no signs of dystonia,
absence of other etiologic factors
(should be bilateral, duration>1 year, affects daily living, family hx, better with ETOH)

53
Q

Essential tremor treatment

A

propranolol, or primidone,

54
Q

Tourette’s diagnostic features

A

2+ motor symptoms,

1+ vocal tics

55
Q

Concussion Risk factors

A 
Dehydration
Fatigue
Malnutrition
Illness
Illicit drug use
56
Q

Frontal Concussion signs

A

irritability

tearfulness

57
Q

Parietal Concussion signs

A

headache

nausea

58
Q

Occipital Concussion signs

A

dizziness, disequilibrium, visual symptoms

59
Q

Top of head impact Concussion signs

A

LOC

60
Q

High risk concussions (3)

A

Double hit, Rotational force

second hit - after previous concussion

61
Q

Concussion Diagnosis

A

new neuro symptoms post injury = Diagnostic

May take min to hours to develop

62
Q

Concussion Physical signs (9)

A

LOC, Headache, N/V, Balance issues, incoordination, dizziness, visual changes, numbness, neck pain

63
Q

Concussion cognitive signs (6)

A

confusion, amnesia, disorientation, blank stare, difficulty concentrating, slurred/slow speech,

64
Q

Concussion emotional signs (4)

A

irritability, sadness, emotional labiality, nervousness

65
Q

Concussion sleep signs (3)

A

drowsiness,
oversleeping
insomnia

66
Q

Concussion require ED eval (6)

A 
prolonged LOC
C-spine injury concern
high impact
skull fracture concern
seizure post trauma
deterioration of condition
67
Q

ED concussion Eval

A

neuro exam q 30 minutes
Hx
observe for 4 hours
Manage symptoms

68
Q

Concussion indications for CT

A

LOC
Abnormal Neuro findings
Deterioration

69
Q

Concussion treatment

A

Responsible adult observation 6-8 hours post injury
Brain rest 24-48 hours
Physical rest until symptom free
NSAIDS and Acetaminphen
(NO cognition altering meds - opioids, muscle relaxants, Benzos, ETOH)

70
Q

Concussion return to school notify

A

teachers, counselor, nurse, athletic trainer, coach

71
Q

Return to play post concussion

A

Successful return to full school day
symptom free off meds
normal neuro exam
Back to base line balance and cognitive performance

72
Q

Chronic traumatic encephalopathy - cause and diagnosis

A

Tau proteins due to repeated Concussions

Post mortem diagnosis

73
Q

Epidural hematoma description

A

arterial bleed, pocket of blood,
often with skull fracture
Pt usually lucid –> rapid deterioration, severe HA, Vomiting, Seizure

74
Q

Subdural hematoma description

A

Venous bleed
Crescent moon shape following skull curvature,
no skull fracture
LOC or coma in acute onset
Chronic - HA, Dizziness, cognitive impairment, seizures

75
Q

Subdural hematoma timeline Acute, Subacute, Chronic

A

Acute 1-2 days post trauma
Subacute 3-14 days post trauma
Chronic >15 days post trauma

76
Q

Acute subdural hematoma (symptomatic) treatment

A

Neurologic emergency

surgical decompression - craniotomy

77
Q

Epidural Hematoma treatment

A

Neurologic emergency,

surgical decompression - craniotomy

78
Q

Epilepsy definition

A

> 2 unprovoked seizures

79
Q

Simple partial seizures - signs and symptoms

A

preserved consciousness, seconds to minutes in duration

May be motor, sensory, autonomic,

80
Q

Simple partial seizures - treatment

A

Anti-epileptic drugs if recurrent

Surgery if medically refractory

81
Q

Complex partial seizure - sign and symptoms

A

impaired consciousness 60-90 seconds w/o recollection of seizure
Behavioral arrest followed by staring, automatism, and post ictal confusion

82
Q

Types of generalized seizure (6)

A 
Absence - staring
Myoclonic - rapid jerks
atonic - flaccid
tonic - 10-20 second rigid extended extremities
Clonic - 1-2 min tremors
Tonic-clonic
83
Q

Absence seizures tx

A

ethosuximide

84
Q

Generalized seizures (not absence) tx (4)

A

valproic acid,
Lamotrignine,
topiramate,
levetiracetam

85
Q

tonic - clonic additional tx (3)

A

zonisamide,
phenytoin,
carbamazepine

86
Q

Tonic - clonic post ictal phase

A

amnesia,
variable consciousness,
stuporous then gradually awakens to confusion/agitation/combative

87
Q

Causes of seizures

A

Primary

Secondary - drugs, infections, metabolic, structural

88
Q

Seizures and ETOH withdrawal

A

If any concern for ETOH withdrawal - ADMIT PT - will get much worse over next 10 days if untreated

89
Q

Status Epilepticus

A

Seizure > 5-10 minutes

2 seizures without lucid interval

90
Q

Acute seizure management -> status epilepticus

A

Airway protection,
Benzos,
Induce coma

91
Q

Stroke in Pregnancy (2)

A

Urgent Head CT for CVA, and

think Eclampsia

92
Q

Criteria for febrile seizure

A

Duration <15 minutes
Fever >100.4
Age 6 months - 5 years
no more than 1 seizure in 24 hours

93
Q

PNES or Pseudo seizure

A

Psych diagnosis
conversion disorder
EEG video monitoring for definitive diagnosis

94
Q

Anti epileptic tx

A

Treat after 2nd seizure or if significant need
avoid driving for 6 months if 2nd seizure
meds for 1 year

95
Q

Anti epileptic drugs (9)

A 
valproic acid
Phenytoin
carbamazepine
levetiracetam
topiramate
lamotrigine
zonisamide
ethosuximide
phenobarb

my clin med 4 (4 decks)

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