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Clinical Medicine > Neurology > Flashcards

Neurology Flashcards

In-class review for exam

1
Q 
Glasgow Coma Scale 
Mnemonics: 
VOICE
Obeys ....
44 ....
A

VOICE for Verbal Response
V: voiceless (1) - O: ooohhh incoherent (2) - I: inappropriate words (3) - C: confused but answers (4) - E: elegant speech (5)

Obeys… for Motor Response
Obeys (6) → Localizes pain (5) → Draws from pain (4) → Bends (3) → Extends (2) → None (1)

44…for Eye Opening Response
44- open eyes = spontaneous opening (4)
3- lips = verbal/speech makes eyes open (3)
2- pointy = ouch open eyes from pain (2)
1- sideways looks like closed eyes no opening (1)

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2
Q 
ID the type of hematoma: 
WITH a lucid interval?
WITHOUT a lucid interval? 
\+
ID anatomic location of blood
A

WITH lucid interval: Epidural Hematoma
-Above the dura mater (lentiform)

WITHOUT lucid interval: Subdural Hematoma
-Below the dura mater/above arachnoid matter (crescent)

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3
Q

55 y.o. smoker w/ hx of HTN, atherosclerosis, & etoh intake experienced a sudden LOC & a sudden severe HA
…
What should be a top differential

A

Subarachnoid Hemorrhage
d/t
Ruptured Saccular (Berry) Aneurysm

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4
Q

Normal intracranial pressure vs. Fatally high intracranial pressure

A

Normal: < 10-15 mmHg
Fatal: > 25-30 mmHg

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5
Q

Indications for ICP Monitoring

A
  1. Inability to follow commands or localize a stimulus
  2. Multiple systems injured + altered LOC
  3. Sedated patient (d/t inability to monitor their mental status)
  4. Known concurrent tx that elevates ICP
  5. Traumatic intracranial mass
  6. Acute fulminant liver failure + INR > 1.5 + Coma
    * In general never do it in a pt who is awake & has normal neruo exam
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6
Q

Treatment for elevated ICP

A
  • Raise HOB 30-45°
  • Normotensive (keep BP normal)
  • Hyperventilate
  • Sedation
  • Mannitol
  • Hypertonic saline
  • Control hyperglycemia
  • Seizure prophylaxis
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7
Q

Transient altered mental status d/t a diffuse traumatic brain injury
-Pathophys: d/t what type of crisis?
-List the “no-go” characteristics & also generally reasons to go to the ER
-

A

Concussion

  • Pathophys: Energy crisis from shearing of axons
  • “No-go”: LOC, Seizure, Fencing, Gross Motor Instability, Confusion, Amnesia, *repeated N/V
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8
Q

Sample Question:
Unidentified male s/p MCC. On arrival to ER, the pt is confused, but able to respond to questions appropriately. He is groggy, but opens his eyes to verbal command and is able to make purposeful motions in response to painful stimuli. Glasgow Coma Score (GCS)?

A

12

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9
Q

Second Impact Syndrome

-Definition

A

Rare Phenomenon when diffuse cerebral swelling develops in the setting of a second head trauma (any severity) occurring while a pt is still symptomatic from a previous concussion, can be deadly

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10
Q

At risk for this if pt is undergoing active litigation, repeat concussions, GCS < 13 on presentation. Generally pt might have chronic HA, difficulty w/ memory, fatigue, sleeping challenges, personality changes, sensitivity to light/noise.
-Tx?

A 
Post-concussion Syndrome 
Tx: 
-Rest, both PHYSICAL &amp; COGNITIVE 
-Symptomatic tx of HA &amp; mood sx 
-+/- referral for neuropsychological testing
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11
Q

In a suspected traumatic brain injury, when is it ideal to perform a Glasgow Coma Scale evaluation? Should be followed up by what?

A

Within 30 minutes of the injury
+
MRI or CT scan

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12
Q

What does Golden Hour refer to?

A

In TBI’s it is essential to treat within the first 60 minutes of presentation! Improves mortality.

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13
Q

Define the following Skull Fractures:

  1. Linear
  2. Depressed
  3. Diastatic
  4. Basilar
A

Linear: break to skull w/o movement (*mc temporoparietal, frontal, occipital)

Depressed: sunken spot

Diastatic: fx along a suture line & it pries apart

Basilar: fx at base of skull (*most serious)

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14
Q

(+) Racoon Sign or battle sign

A

Basilar skull fx

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15
Q

Post skull fx, note clear fluid on pts pillow, it could have been from their nose or ear, you suspect…

A

Basilar skull fx

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16
Q

MC artery ruptured in an Epidural Hematoma

A

Middle Meningeal Artery

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17
Q

Arterial blood + above dura + lucid for several hrs + craniotomy if > 30 cm^3

A

Epidural Hematoma

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18
Q

Venous blood + below dura + NOT lucid + fall or MCV or assault

A

Subdural Hematoma

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19
Q

What is it called when an elderly pt has a subdural hematoma that progressively presented w/ sx

A

SUBACUTE subdural hematoma

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20
Q

Caused by an injury to vasculature of the brain

  • Presentation?
  • Can be fatal if ICP is at what value?
  • Treatment?
A

Subarachnoid Hemorrhage or Brain Herniation
Presentation: Sudden, severe HA, +/- focal neural deficit, ↑ BP
Fatal ICP if > 25-30 mmHg
Treatment:
-Control BP
-Surgical: clipping or wrapping aneurysm or catheter to remove embolization

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21
Q

Prognosis for Subarachnoid Hemorrhage

A

⅓ survive + good recovery
⅓ survive + disability
⅓ die

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22
Q

Repetitive mild head injury
Observed in athletes or military personnel
Tau degenerative change at superficial cortical layer of brain
Cognitive, behavioral, mood sx
Supportive tx only

A

Chronic Traumatic Encephalopathy

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23
Q

AEIOU TIPS

A 
Possible causes of Dementia 
A: alcohol or AAA
E: electrolytes or endocrine 
I: insulin/blood sugar 
O: opiates 
U: uremia 
T: trauma, temp or toxemia 
I: infections (sepsis, meningitis) 
P: psychogenic or pulmonary embolus
S: space occupying lesion/strokes/shock/seizure
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24
Q

3 assessments for Altered Mental Status suspected to be from damaged brainstem function

A
  1. Corneal Reflex
  2. COWS
  3. Doll’s Eyes
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25
Q

Always consider these 3 reversible causes of Altered Mental Status

A
  1. Hypoglycemia (check glucose → +/- give dextrose)
  2. Opiate overdose (trial of naloxone)
  3. Thiamine deficiency (trial of thiamine)
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26
Q

AVPU Scale

A 
Assess Altered Mental Status 
A: alert
V: verbal
P: pain
U: unresponsive
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27
Q

Definitions:

  1. Confusion
  2. Drowsiness
  3. Lethargy
  4. Stupor
  5. Coma
  6. Delirium
A

Confusion
Behavioral state of ↓ mental clarity, coherence, comprehension, reasoning
Drowsiness
Patient not easily aroused by touch or noise, cannot maintain alertness for some time
Lethargy
Depressed mental status, pt can appear wakeful but w/ ↓ awareness of self/environment/globally, cannot be aroused to full function
Stupor
Takes vigorous stimuli to wake the pt, and pt does put in an effort to avoid uncomfortable or aggravating stimulus
Coma
Unable to arouse pt by stimulation, and pt DOES NOT put in an effort to avoid painful stimuli
Delirium
Acute onset of fluctuating cognition w/ impaired attention & consciousness, ranges from confusion → stupor

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28
Q

Method to assess Delirium

A

CAM

Confusion Assessment Method

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29
Q

Acute confusional state

Transient global disorder of attention + clouding of conscience

A

Delirium

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30
Q

These are all types of what?

  • Sundowning
  • ICU psychosis
  • Terminal
A

Delirium

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31
Q

MC cause of delirium in hospitals?

Other causes in general?

A

Hospitals: Withdrawal (etoh or substance)

General: Systemic problem (meds, hypoxemia, infection)

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32
Q

Which one has a primary deficit in ATTENTION?

Dementia or Delirium?

A

Delirium

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33
Q 
Attention deficit 
Rapid onset + Fluctuating 
Anxiety
Irritability 
HYPO or HYPER reactive
A

Delirium

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34
Q

Delirium

Treatment

A
  1. Prevention
  2. ID underlying cause & resolve it
    - Remove offending factor, like medication (especially opioids)
  3. Significant behavioral control issues + Subjective distress → Haloperidol
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35
Q

Delirium

Prognosis

A
  • Typical 1 week duration
  • Full recovery (usually)
  • Some never return to baseline
  • Associated w/ worse clinical outcomes overall
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36
Q

Progressive decline in INTELLECTUAL function w/ loss of short term memory + 1 additional cognitive deficit
-What stays preserved?

A

Dementia

Preserved: Attention/Motor function/Speech

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37
Q

All pts > 70 y.o. must receive a Screening Mental Exam to ID what?

A

Dementia

*50% of ppl > 85 y.o. have Dementia

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38
Q

Irreverisble vs. Reversible causes of Dementia

A

Irreversible causes:
Alzheimer’s, vascular dementia, Creutzfeldt-Jakob dz
Reversible causes:
Depression, vit B12 deficiency, syphilis, hypothyroidism, NPH, drug use, intracranial mass

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39
Q

Dementia

Treatment

A
  1. Depression Screening
  2. Aerobic Exercise Daily
  3. Frequent Mental Stimulation
    * Unlikely to regain lost skill s
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40
Q

Early loss of short term memory, a neruodegenerative dz, variable deficits of executive function, visuospatial function, & language

A

Alzheimer’s

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41
Q

MC age related neurodegenrative dz

A

Alzheimer’s

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42
Q

2nd MC age related neurodegerative dz

A

Parkinson’s

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43
Q

ß-amyloid peptide plaques + neurofibrillary tangles w/ tau protein
Found throughout the neocortex
Cholinergic deficiency → memory, language, visuospatial changes

A

Alzheimer’s

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44
Q

Alzheimer’s Sx

A

1st Sx → steady progression of SHORT term memory loss
Progresion to → long term memory loss, disorientation, behavioral & personality changes
↓ intellectual function & cognition

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45
Q

Mental Status Exam shows intellectual decline in > 2 ares of cognition

A

Alzheimer’s

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46
Q

Alzheimer’s

Treatment

A

Cholinesterase Inhibitors: Donepezil, Rivastigine, Galantamine Tacrine

NMDA Antagonist: Memantine (MOD-SEVERE Alzheimer’s)

Best combo: Cholinesterase Inhibitor + NMDA Antagonist

*SAME tx in lewy body dementia

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47
Q

Cognitive, dysfunction, neruodegenerative dz, variable deficits of executive function, visuospatial function, hallucinations & language w/ onset earlier in life

A

Lewy Body Dementia

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48
Q

Lewy Body Dementia

Sx

A 
Psychiatric disturbance + …
→Anxiety w/ visual hallucinations
→Fluctuating delirium 
Parkinsonian motor defects 
80% have hallucinations
49
Q

Histologically indistinguishable from Parkinson’s

α-synuclein containing Lewy bodies occur at brainstem, midbrain, olfactory bulb, & the neocortex

A

Lewy Body Dementia

50
Q

Excess CSF accumulating in the ventricles possibly linked to PMHx of head injury

A

Normal Pressure Hydrocephalus

51
Q

Normal Pressure Hydrocephalus

Sx

A

Gait apraxia (magnetic gait)
Urinary incontinence
Dementia

52
Q

Diffuse disease of the brain that alters brain function or structure
Rare in humans
Invariably fatal
-Which is the most common?

A

Prion Disorder

-MC: Sporadic Cretzfeldt-Jakob Disease

53
Q 
Cognitive decline 
Myoclonic fasciculations
Ataxia
Visual disturbance 
Pyramidal &amp; extrapyramidal sx 
Variant type found in young people w/ prominent psychiatric or sensory loss
A

Prion Disorder

54
Q

The only drug that can help with cognitive decline in a Prion Disorder, but ultimately does not at all help the progression toward death.

A

Flupirtine (analgesic)

→Possibly slows cognitive decline

55
Q

Wernicke’s Encephalopathy

  • Definition
  • MC cause in US
  • Sx (3)
  • Tx
A

Wernicke’s Encephalopathy

  • Definition: degenerative brain disorder d/t lack of thiamine (B1)
  • MC cause in US: Alcoholism
  • Sx: 1. Confusion 2. Ataxia 3. Ophthalmoplegia/nystagmus
  • Tx: Thiamine 100 mg
56
Q

Any combination of tremor, rigidity, bradykinesia, & progressive postural instability
+/- cognitive impairment

A

Parkinsons Disease

57
Q

Required: Bradykinesia + 1 additional cardinal feature of TRAP
….
Like what & for what ctn?

A 
Tremor
Rigidity
Akinesia
Postural instability  
for 
Parkinsons
58
Q

How are the following Parkinson’s meds prescribed for the situations below…
Meds: Selective MAOI, Amantadine, Dopamine Agonist, Levodopa

Scenarios: 
Mild Sx: 
> 70 y.o. + severe motor deficit: 
Young patient:
Mild/need to potentiate levodopa:
A 
Mild Sx: 
→Amantadine (old tx probs not used anymore) 
> 70 y.o. + severe motor deficit: 
→Levodopa
Young patient:
→Dopamine agonist + Levodopa
Mild/need to potentiate levodopa: 
→Selective MAOI
59
Q

After suffering a severe TBI how likely are you to develop Parkinson’s?

A

45% MORE likely than the average person

60
Q

Dopamine depletion from degeneration of the dopaminergic nigrostriatal system/ substantia nigra pars compacta → imbalanced dopamine & acetylcholine

A

Parkinsons Disease

61
Q

What are the most minimal requirements to make a clinical diagnosis of Parkingsons

A

Required: Bradykinesia + 1 additional cardinal feature of TRAP

62
Q

Pill Rolling Resting Tremor

A

Parkinsons

63
Q

Postural tremor that emerges when performing an action (not present at rest)
…
Is most likely what?
What is a treatment?

A

Essential Familial Tremor

Tx:
Propranolol

64
Q

CAG trinucleotide repeat

  • What inheritance?
  • What is its classic motor abnormality?
  • Prognosis?
A

Huntington’s

  • Inheritance: Autosomal dominant (Chromosome 4)
  • Chorea
  • Pt dies 15-20 yrs after onset of clinical sx
65
Q

Degeneration at anterior horn cells of spinal cord, motor nuclei of the lower cranial nerves, & at the corticospinal & corticobulbar pathways
+
3 regions of denervation & spontaneous resting muscle activity

A

Amyotrophic Lateral Sclerosis

  • Must have 3 regions of changes on Electromyography:
    1. Cervica. 2. Throacic 3. Lumbosacral
66
Q

Riluzole

  • Treats what ctn?
  • What supportive tx must accompany it?
  • Prognosis?
A 
Amyotrophic Lateral Sclerosis 
*riluzole is a glutamate blocker fyi 
Supportive: 
\+/- non invasive ventilation 
\+/- assertive devices 
\+/- physical therapy

Prognosis:
Fatal, in 3-5 yrs of onset

67
Q

Multiple motor or phonic (or both) tics
Onset typically prior to 18 y.o., MC between ages 2-15 y.o.
Tx?

A

Tourette Disorder

Preceded by an urge & relieved by performance

Tx:
Cognitive Behavioral Therapy
Clonidine (α-agonist)

68
Q

This disorder involves motor & phonic function that occurs b/c pt cannot resist the urge & the urge is resolved by performing
+
Tx

A

Tourette Disorder

α-agonists: Clonidine
Other: Tetrabenazine, RisperidoneHaloperidol 
Fluphenazine or Pimozide 
Motor/facial only: Botox injection 
Deep brain stimulation
69
Q

CNA immunoglobulin production + altered T lymphocytes characterized by inflammation w/ multiple foci of demyelination in CNS + HLA DR2/↓ Vit D/Smoker
-What ar the MC ages of onset?
-

A

Multiple Sclerosis

70
Q

Reactive gliosis

A

Multiple Sclerosis

-Damage from the CNS insult & demyelination cause glial cells to hypertrophy

71
Q

4 types of MS

A 
Relapsing-remitting: 
Exacerbation &amp; remission cycles 
Spontaneous 
\+/- triggered by infection 
Primary progressing:
Gradual progression w/o remission 
\+/- temporary plateaus 
Secondary progressing: 
Starts like relapsing-remitting then turns into gradual progression 
Progressive relapsing: 
Progresses gradually → sudden, clear relapses interrupt
72
Q

Multiple Sclerosis

Symptoms

A

Paresthesias in > 1 extremity or on the Trunk or on 1 side of the Face

Weakness, numbness, tingling, unsteadiness on a limb

Lhermitte’s sign: electric shock sensation in limbs & torso after movement of neck
Uhthoff’s phenomenon: worsening symptoms w/ heat

73
Q

Lhermitte’s Sign

A

electric shock sensation in limbs & torso after movement of neck
from MS

74
Q

Uhthoff’s Sign

A

worsening symptoms w/ heat

from MS

75
Q

2 ways of diagnosing MS w/ MRI imaging

A

> 2 CNS lesions/plaques for dx
Single pathologic lesion w/o explanation for the finding
→Clinically Isolated Syndrome (CIS) dx
→F/U MRI in 6-12 m.o. to assess any new lesions

76
Q

Acute Relapse:
Corticosteroids → Methylprednisolone IV (TID) → Prednisone PO (1wk + 2-3 wk taper)
Prevention of a Relapse:
Immunomodulation
Spasticity:
Baclofen or tizanidine
Pain:
Gabapentin or TCA (like amitriptyline) or carbamazepine or opioids
Severe, intractable:
Plasma exchange, hematopoietic stem cell transplant
Fatigue:
Amantadine, modafinil, armodafinil, or extended release amphetamine
Behavioral modifications
….
What is this tx for? What is its goal?

A

Multiple Sclerosis

Goal: preventing relapses + ↓ accumulation of disability

77
Q

Fluctuating weakness of commonly used voluntary muscles
Diplopia, ptosis & difficulty swallowing
Activity increases weakness of affected muscles
-What can improve ptosis?
-Pathophys?
-3 diagnostic tests?

A

Myasthenia Gravis

  • Ice Test
  • Auto-antibodies vs. acetylcholine receptors (↓ # functional receptors)
    1. Ab vs. receptors 2. LDL receptor related protein 3. Tensilon Test/Edrophonium Test
78
Q

Myasthenia Gravis

Treatment

A
  • Neurology referral
  • Neostigmine/Pyridostigmine (anti-cholinesterase-short acting)
  • Thymectomy
  • Unresponsive to -stigmines or surgery: Corticosteroids (prednisone)
  • Refractory: mycophenolate mofetil/cyclosporine
  • Major disability or Myasthenic crisis: Plasmapheresis/IVIG therapy
79
Q

Thymoma + Myasthenia gravis =

A

MC in older men

80
Q

Group of CNS disorders associated to Muscle Tone, Strength, Coordination, Postural Abnormalities d/t injury at the perinatal or prenatal period

  • Sx?
  • Tx?
A 
Cerebral Palsy
Sx: 
Spasticity (75%) 
Motor deficit: Hypotonia, fine motor difficulty, ataxia, dystonia
Tx: 
Supportive
81
Q

Urge to move legs + immediate relief after moving legs or walking

  • What should be part of the workup?
  • Tx?
A

Restless Leg Syndrome

  • Workup: Iron deficiency
  • Tx: Pramipexole, ropinirole (dopamine agonists)
82
Q

Muscular Dystrophy
-Definition
-MC type, 2nd common type
(general patho)

A

Progressive muscle WASTING & WEAKNESS
MC: Duchenne (ABSENCE of dystrophin)
2nd common: Becker (ABNORMAL dystrophin)

83
Q

Pt w/ hypertrophied calf muscles + inability to climb up their stairs at home + intellectual disability

  • Dx?
  • 2 tests that can support your dx?
  • Tx?
A

Dx: Muscular Dystrophy
L/T:
1. CK: ↑ if d/t Duchenne or Becker MD
2. Muscle Bx: (+) muscle wasting

Tx:

  1. Eteplirsen (dna modulation)
  2. Corticosteroids
84
Q

NF1 gene mutation on Chromosome 17
vs.
NF2 (Merlin) gene mutation on Chromosome 22

A

Nerurofibromatosis

Chromosome 17 = Type 1 → neurofibromas anywhere on the body/skin

Chromosome 22 = Type 2 → neurofibromas on CN 8 or intracranially/intraspinally

85
Q

Sensory: hyperalgesia, &/or allodynia (sensory stimulus worsening pain)
Vasomotor: skin, temperature, color asymmetry
Sudomotor/edema: edema, sweating changes, or sweating asymmetry
Motor/trophic: ↓ ROM or motor dysfunction &/or trophic changes (hair, nail, skin)
…
With this information, how can someone get dx w/ Complex Regional Pain Syndrome?

A

Limb Pain + >/= 1 sx from 3 of 4 categories listed

CLASSIC TRIAD:

  1. Burning pain
  2. Autonomic dysfunction
  3. Trophic changes
86
Q

Non dermatomal limb pain after trauma or surgery w/ sensation of burning pain, autonomic dysfunction, & trophic
-Tx?

A

Complex Regional Pain Sydnrome

Tx:
NSAIDs
Prednisone
Gabapentin

87
Q

Shoulder-pain syndrome

A

Hand + Ipsilateral ROM of shoulder w/ Complex Regional Pain

  • **MC in hand
  • **This syndrome can also occur
88
Q

Gullian-Barre Syndrome
Definition
-MC post infectious care
-Most significant iatrogenic cause

A

Acute immune-mediated progressive polyneurophathy + progressive muscle weakness

  • Campylobacter jejuni infx
  • Post-immunization
89
Q

Ascending progressive & often symmetric muscle weakness (legs → arms) + ↓ reflexes+ acute polyneuropathy

  • Dx?
  • 2 diagnostic criteria
  • Serology finding?
  • Tx?
A

Gullian-Barre

2 Diagnostic Criteria:

  1. Progressive weakness of legs & arms
  2. a-reflexia or ↓ reflexes in weak limbs

Serology: (+) antibodies for glycolipid Gl1b

Tx: 
#1: Plasmaphoresis 
#2: IVIG
90
Q

Gullian Barre:

  • When can someone have a vaccine?
  • General functional prognosis at 1 yr?
  • Deadly complication?
A

After 1 year → immunizations should be considered on an individual basis

At 6 m.o. 80% of ppl can walk

Paralysis of chest muscles/diaphragm → respiratory failure

91
Q

Pain, burning, tingling at hand during sleep

  • Dx
  • Sx anatomic distribution?
  • What PE tests would be (+)?
  • Non pharm tx?
  • If sx persist > 12 m.o.?
A

Carpal Tunnel Syndrome

Median Nerve Innervation:
1st 3 digits + radial ½ of the 4th digit

Splint at neutral 30° flexion for < 3 m.o.

Carpal tunnel surgical release if sx persist x > 12 m.o.

92
Q

2 significant Risk Factors
Duration & severity of hyperglycemia
Glycemic variability

…
For what condition?

A

Diabetic Peripheral Neuropathy

93
Q

5.07 Semmes-Weinstein Monofilament Test

A

Used to ID Diabetic Peripheral Neuropathy

94
Q

MC complication of DM2

A

Diabetic Peripheral Neuropathy

95
Q

Hyperglycemic oxidative stress leading to neuronal damage + symmetric distal sensory loss (burning/weakness) + worse at night

  • Dx?
  • Tx?
A

Diabetic Peripheral Neuropathy
Tx: (TCA’S)
Nortriptyline
Desipramine

96
Q

Screening Indications for Diabetic Peripheral Neuropathy

A

DM2 at Diagnosis
DM1 at 5 yrs post-diagnosis
Prediabetics w/ sx
SUBSEQUENTLY to 1st screening must repeat Q-annually

97
Q

Method of screening for Diabetic Peripheral Neuropathy

A

Thermal or Pin Prick (small nerve function)
Vibration, proprioception, monofilament, DTR at ankle vs more proximal locations (large nerve function)
Michigan Neuropathy Screening Test
> 4 Points → Neuropathy
PE Score >/= 2.5 indicated sc of neuropathy

98
Q

Rocker bottom foot

A

Diabetic neuropathic arthropathy (charcot foot)

Collapse of the medial arch
Medial convexity
Deformity caused by displacement of the talo-navicualr joint & tarsometatarsal dislocation

99
Q

Unilateral warmth, redness, & edema over the foot/ankle + DM
…
Always r/o what?
Tx?

A

Diabetic neuropathic arthropathy (charcot foot)

Tx:
Non-weight bearing + cast 
3-25 m.o. (non-removable cast)
3-26 mo.o (removable cast) 
Manage inflammation 
Podiatry for footwear 
Surgery
100
Q

Wide spectrum of manifestation affecting different orang systems
Secondary to DM
Systems:
GI, CV, GU, pupillary, sudomotor, neuroendocrine

Sx: GERD, Gastroparesis, Chronic Diarrhea

A

DIABETIC AUTONOMIC NEUROPATHY

101
Q 
Severe shoulder pain followed within days of weakness, reflex changes, sensory disturbances at the distribution of C5/6
Wasting of affected muscles 
d/t:
Idiopathic 
Trauma 
Including at time of vaginal delivery 
Resulting from a congenital anomaly 
Neoplastic
A

BRACHIAL PLEXUS NEUROPATHY

102
Q

2 types of Bell’s Palsy

A

CN 7 palsy

Central: 
Preserved ability to frown 
Eye unaffected 
(+) mouth drooping
Peripheral: 
Inability ability to frown 
Ptosis (Eye affected)
(+) mouth drooping
103
Q

Essential in diagnosing someone with Bell’s Palsy +Tx?

A

Rule out other causes, especially stroke

Tx:
High dose Prednisone x 1 week

104
Q

Trigeminal Neuralgia (CN 5)
Causes (2)
Sx
Tx

A

Causes: 1. neighboring vessel compression 2. underlying ctn like MS

Sx: Sudden stabbing/lancinating facial pain

Tx: conservative, like carbamazepine

105
Q

Which CN causes:

Defect in smell (ansomia)

A

CN 1

106
Q

Which CN causes:

Impaired vision

A

CN 2

107
Q

Which CN causes:

Out & down tilt of eye

A

CN 3

108
Q

Which CN causes:

Up & in tilt of eye

A

CN 4

109
Q

Which CN causes:

Inward tilt of eye

A

CN 6

110
Q

Which CN causes:
Absent corneal reflex/anestheisa of forehead
Anesthesia of midfac e
Jaw deviation toward lesion

A

CN 5
1
2
3

111
Q

Which CN causes:

Horizontal diplopia

A

CN 3 & 6

112
Q

Which CN causes:

Vertical diplopia

A

CN 4

113
Q

Which CN causes:

Sensorineural hearing loss, horizontal nystagmus, vertigo

A

CN 8

114
Q

Which CN causes:
Posterior 1/3 of tongue w/o taste or sensation, no sensory at soft palate/upper pharynx, flaccid paralysis of soft palate, uvula deviates away from lesion

A

CN 9

115
Q

Which CN causes:
Epiglottic paralysis, flaccid paralysis of soft palate w/ uvula pointing away from lesion, vocal cord issues, stomach gastroparesis

A

CN 10

116
Q

Which CN causes:
Sternocleidomastoid paresis
Trapezius paresis

A

CN 11

117
Q

Which CN causes:
Tongue atrophy
Fasiculation of tongue

A

CN 12

118
Q

Unilateral periorbital pain > 15 min + 1 of the following:
Ipsilateral nasal congestion or rhinorrhea, or lacrimation or redness of eye
Horner syndrome (ptosis, pupillary meiosis & facial anhidrosis or hypohidrosis)

Tx in ER setting:

A

Cluster HA

ER:
100% O2 12-15 L x 15 minutes
+- Triptans

Clinical Medicine (6 decks)

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