9. Neurology Flashcards by Dave hwangbo

sudden onset ipsilateral hyperacusis (Ear pain) + Complaining of waking up with Unilateral facial paralysis + uable to lift eye brow or forehead

Name/Risk/Nerve/PE/Tx

Name: Bell’s palsy

Risk: HSV

Nerve: CV7 (facial nerve)

PE: unable to wrinkle both side

Tx: Prednison (less than 72 hrs), artificial tear for lacrimation, Acyclovir

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hx of DM + numbness tingling at lower extremities

Name/Tx

Name: Diabetic neuropathy

Tx: Gabapentin for pain, DM control

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Ascending(leg first -> arm) weakness (usually symmetric) + DTR decreased + breathing difficulty

Name/Pathogen/Dx/Tx/contraindication/Complication

Name: Guillian Barre syndrome

Pathogen: Campylobacter Jejuni

Dx: CSF (protein high/Normal WBC)

Tx: Plasmapheresis, IVIG

Contraindicated Prednisone

Complication: Repiratory failure

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worsened with repetitive movement (worsen throughout the day/better with rest) + eye lid weakness + breathing problem

Name/Risk/PE/Dx/Tx

Name:MG (myasthenia gravis)

Risk: young women/Thymic abnormality

PE: DTR normal, respiratory muscle weakness

ACTH receptor antibodies
edrophonium (tensilon) test
ICE pack test (10 min on eyelid better)
Rule out CT or CXR for Thymoma

Pyridostigmine (1st)
IVIG/Plasmapheresis
Thymectomy

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Throughout the day weakness gets better + weight loss

Name/Related/Patho/Dx/Tx

Name: Lambert-Eaton

Related: SCC

Patho: antibodies against presynaptic voltage gated calcium channels prevents ACTH

Dx: electrophysiology

Tx: plasmapheresis (1st), remove tumor

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Bilateral tight band like (vise like) HA + No N/V + focal neurologic (photophobia)

Name/MC type HA/Tx/Prophylaxis

Name: Tension HA

MC common type: Tension

Tx: NSAID, acetaminophen

May be used for TCA, antimigrain med, BB for prophylaxis

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Unilateral HA + visusal change

Name/Risk/Type/Aura/caution/Tx/Prophylaxis

Name: Migraine HA

Risk: MC in Women

Type: classic (with aura), Common (without aura)

Aura: scotoma (blind spots), light flash

Caution: always remember focal neurologic problem possible Stroke

Tx: Triptans

CI: CAD, uncontrolled HTN or MI

Prophylaxis: BB, CCB, TCA, NSAID

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Unilateral HA + around eye pain + lacrimation

Name/Risk/Trigger/Tx/Prophylaxis

Name: Cluster HA

Risk: Males (young/middle age)

Trigger: ETOH, Worse at night

Tx: 100% O2, Triptan meds

Prophylaxis: Verapamil

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Meningitis Definition/MC/MC important/Less common/Age group

Definition: infection of membranes covering the brain and spinal cord

MC common: Viral

Most important: Bacterial

Less common: TB, Fungal

Age group Bacteria Pathogen

less than 1 month - GBS, lister
1 mo - 18 yrs - N Meningitidis, H flu
18yr - 50 yrs - S pneumo
50 yr above - S pneumo, listeria
Farm worker, pregnancy - listeria

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Fever/chill + nuchal rigidity (stiff neck) + alter mental status

Name/PE/Dx/Tx/Prevention/Post exposure (alternate)

Name: Baterial meningitis

Brudzinski - neck flex + knee hip flex
Kenig - can’t straighten knee when hip flexed

Dx: CT head (1st), LP (definitive)

Tx: Abx + Admiti ICU

neonate (less than 1 month) - cefo + ampicillin
1 mon - 50y - ceftx + vanco
50y above - ceftx + ampicillin + vanco
Dexamethasone - if strep pneumo (prevent hearing loss H flu)

Prevention: Hib, MCV

Post exposure: Cipro 500mg x 1 dose/alternate Rifampin

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Encephalitis vs viral meningitis

Define/Etiology/clinical menifestation/dx/tx

Encephalitis

Define: infection in Parenchyma
Etio: HSV
Clinical menifestation: lethargy, AMS, abnormal brain function
Dx: LP - high WBC, normal glucose
Tx: supportive care

Viral meningitis

Define: infection in Meninges
Etio: Enterovirus (coxackie)
Clinical emnifestation: HA, fever, Brudzinski & Kernig sign, Normal brain function
Dx: CSF - High WBC, Normal glucose
Tx: Supportive care

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Bacteria/Viral/Fungal CSF difference

Bacteria

Opening pressure high, Glucose low, Protein high, PMN (neurtrophil) high

Viral/Encephalitis

Opening pressure normal, Glocose normal, protein high, WBC high

Fungal

Opening pressure Normla or high, Glocose low, protein high, WBC high

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Hx of sinus infection or ear infection + HA + fever + neurologiccal finding

Name/Tx

Name: Cerebral abscess

Tx: Ceftx + Metronidazole + surgical drainage

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Tremor with movement and resolves at rest or drinking ethanol + often shaky voice + normal DTR and tone

Name/Risk/Tx

Name: Essential tremor

Risk: Elderly, MC movement disorder

Tx: Propanolol

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hx of father died in early + behavior change + dementia + Choreiform

Name/Patho/Dx/Tx

Name: Huntington’s disease

Patho: autosomal dominant (50% chance to get it if one of parent has it)

Dx: CT scan (caudate/cerebral nucleus atrophy)

Tx: none (die in 30-50), Benzo helpful

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Resting tremor + bradykinesia (slow movement) + rigidity (cogwheel) + fixed facial expression

Name/Define/Related/Tx

Name: Parkinson disease

Define: dopamin depletion

lewybodies(misfolded protein - accumulation cause death)
loss of pigment cell seen in the substaintia nigra (contain lots of dopamin makes color - loss cell make depigment)

Tx: Levodopa/carbidopa

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Acutely Confused

Name/Risk/Tx

Name: Delirium

Risk: Dementia predisposition

Tx: Underlying cause (Lorazepam)

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Children with verbal tics (repeat phrase, throat clearing) or motor tics (blinking, shrugging, head thrusting, sniffling)

Name/Tx

Name: Tourette syndrome

Tx: habit reversal therapy (pimozide)

Decline of memory overtime + elderly

Name/Related/Worsen comobid/Dx/Tx/Other dementia (4 type)

Name: Dementia

Related: MC alzheimer, vascular demntia(2nd)

Worsening: UTI, TSH

Dx: CT scan

Tx: Alzheimer - Donapezil, Vascular - ASA

Other dementia type

Alzheimer (1st)
Vescular (2nd) - launar infarcts
Frontotemporal dementia - localized brain degen (personality chang)
Lewybody - visual hallucination

Uni eye pain + loss of color vision + babinski test upwards

Name/Patho/MC subtype/Risk/Dx/Tx

Name: MS (mutiple sclerosis)

Patho: autoimmune, inflammatory demyelinating disease

MC subtype: relapsing-remitting

Risk: 20-40 female

Dx: MRI - periventricle view shows white matter plaque, LP - IgG (oligoclonal bands) in CSF

Tx: Acute - IV corticosteriod, Plasmapheresis

relapsing-remitting - B- interferon

Seizure classification 3 major with subtype explain

Partial (focal) seizure - hemisphere brain effect
- Simple - remembers + sensory strange (taste problem) + jerking
- Complex - doen’t remember + Automatisms (lip smacking, manual picking, patting)
General seizure - both hemisphere brain effect
- Absense (petit mal) - childhood, brief staring eye twitching, loss and gain conciouseness (brief)
- Tonic clonic - rigidity, jerking fall backword, LOSS CONCIOUSNESS
- Myoclonic - short muscle twiching
- Atonic - relaxed fall forward (loss of posture tone)
Status epilepticus - repeated gen seizure without recovery

EEG shows 3 HZ spike wave

Name/Risk/Presents/Dx/Tx

Name: Absence seizure

Risk: young child (stop after 20)

Presents: Relaps of conciousness (lose and gain) + staring, eyelid twitching

Dx: EEG

Tx: Ethosuximide

Treatment of seizures

Partial seizure - carbamazepine

General

absence - ethosuximide
grand mal, myclonic - vaproic acid
Epilepticus - lorazepam, diazepam -> phenytoin -> phenobarbital

Mixed upper and lower motor neron signs + sensation, urinary spincter, voluntary eye movement are spared

Name/Tx

Name: ALS (amyothrophic lateral sclerosis)

Tx: Riluzole (reduce progressive upto 6month) fatal in 3-5 years

burning sensation at leg + Worse at night + improve with movement Name/Tx

Name: Restless legs syndrome Tx: dopamin agonists (pramipexole,Ropinirole) * Iron supplement (check ferritins level lower than 75)

hx of birth defect (limb-length discrepancies) + intellectual/learning disabilities Name/PE/Tx

Name: Cereberal palsy PE: hyperreflexia Tx: multidisciplinary approach, improve spasticity - diazepam

facial burning, pain with wind blowing, touch, eating Name/Tx

Name: TGN (trigeminal neuralgia) Tx: carbamazepine

HA + visual change + papilledema + CT scan no mass found Name/Dx/Tx

Name: idiopathic intracranial HTN Dx: CT(1st) -\> LP - increased pressure with normal glucose Tx: acetazolamide

Dementia + gait disturbance + urinary incontience + MRI large venticle + No abnormal CSF Name/define/Tx

Name: Normal pressure hydrocephalus Define: dilation of the cerebral without abnormal CSF Tx: Ventriculoperitoneal shunt

Sport activities with loss of conciouse + confusion + amnesia Name/Dx/Tx

Name: Concussion syndrome Dx: CT (1st for acute), MRI for 7-14 days event/worsening sx Tx: Cognitive & physical activities rest * if sx resolved they can resume activities - if more than 3 consecutive concussion must stop activities for whole season

Vertical compression accident vs hyperextension of the skull accident Name/Dx/Tx

* Vertical compression - C1 fx (jefferson) * Dx: Lateral X-ray (open mouth view) * Tx: non op - collar x 6-12 wks * hyperextend - C2 fx hangman * Dx: CT scan * Tx * less than 3mm displace collar 4-6week * 3-5mm displace close reduction * more then 5mm displace OP

hx of atherosclerosis + BP difference between arms Name/Dx/Tx

Name: subclavian steal syndrome Dx: CT angio Tx: revascularization

Spinal cord injury Mechanism of injury/deficit

* Anterior cord * Mechanism of injury: direct compression (blow out vertebral body burst) * Deficit - lower \> upper (bladder dysfunction) * Central cord * Mechanism of injury: Incomplete cord syndrome, hyperextension MVA * Deficit: upper \> lower (shawl distribution) * Posterior cord * Mechanism of injury: rare * Deficit: loss of proprioception & vibratory sense only (normal temperature and no pain) * Brown sequard * Mechanism of injury: stabbing trauma (unilateral damage) * Deficit * Ipsilateral - motor, vibration & proprioception problem * contralateral - pain & loss of temp

Brain damage left vs right side, broca vs wernicke

* Left - dominant (speech language) right side weakness, sensory * right - nondominant (flat affect, impaired judgment), left side weakness, sensory * Broca apasia - difficulty speaking with comprehension ability * Wernicke apasia - difficulty speaking with no comprehension ability

sudden weakness of extremity + amaurosis fugax (monoocular vision loss) + recovers after couple hours(less than 24 hrs) Name/Risk/PE/Dx/Tx/Contraindication

Name: TIA (transient ichemic attack) Risk: DM, HTN, aFib PE: Amaurosis fugax Dx: CT scan Tx: ASA + clopidogrel * **Thrombolytic contraindicated**

Stroke location 1. MC stroke location? 2. Face and arm 3. Leg and foot + face spared 4. crossed sx (visual hallucination) 5. Stroke Dx? 6. Stroke Tx?

1. lacunar infarct 2. middle cerebral artery 3. anterior cerebral artery 4. Posterior cerebral artery 5. CT noncontrast 6. Thrombolytic in 3 hours (alteplase) CI: 185/110 or any recent bleeding

temporal bone fx + convex on CT Name/location/Dx/Tx

Name: Epidural hematoma Location: arterial bleed (between skull and dura) Dx: CT (convex, do not cross suture line) Tx: small observe, ICP high - mannitol

blunt trauma + Concave on CT Name/location/Dx/Tx

Name: subdural hematoma Location: venous bleed (bridge vein) Dx: CT concave (cross suture line) Tx: Supportive

Thunderclap + worst HA of my life Name/Dx/Tx

Name: SAH (subarachnoid hemorrhage) Dx: CT first none then DO, LP (high open pressure + RBC or xanthocromia), Confirm by 4 vessel angiography Tx: Nicardipine, nimodipine (gradual BP drop)

hx of HTN + HA, N/V + CT shows bleeding Name/Dx/Tx

Name: ICH (intracerebral hemorrhage) Dx: CT (intraparenchymal bleed), DO NOT perform LP (may cause herniation) Tx: Supportive (ICP high - mannitol)

Sensitive touch (cold) + Burning thrombing pain and swelling at extremities (arm & leg) + hx of stroke, injuries site (4-6weeks ago) Name/History/Tx/Prevention

Name: Complex regional pain syndrome History: 4-6 weeks after fx or surgery Tx: PT (1st) + NSAID, gabepentin Prevention post fx: vitamin C helpful to prevent

Recurrent HA in children + seizure + intracranial hemorrhage in image Name/Patho/Dx/Tx

Name: AV malformation Patho: Artery to vein transfer without passing capillary system Dx: MRI(initial), X-ray angiography (gold) Tx: Neurosurgery referral

Mad cow disease caused by what?

Prion

EPS 4 type sx and tx

Typical \> atypical antipsychotics Acute dystonia: muscle spasms, stiffness, oculogyric crisis, tx: benztropine, dyphenhydramine Akathisia: restlessness, tx: benztropine Bradykinesia: Parkinsonism, tx: benztropine Tardive dyskinesia:orofacial involuntary movements, Tx: Stop offending agent