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Step 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the ddx for spinal cord compression?

A

metastatic cancer

primary tumors

transverse myelitis

epidermal abscess

epidural hematoma

herniated disc

spondylosis

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2
Q

How to work up spinal cord compression with symptoms?

A

start steroids (dexamethosone)

MRI

neurologic emergency! may need surgery

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3
Q

What are the red flags in back pain (cord compression)?

A

unremitting back pain

constant pain at night

pain worse with laying down

neuro symptoms

sexual function deficits

age >50

prior cancer hx

unexplained weight loss

pain lasting > 1 month

no improvement following conservative tx

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4
Q

What is the next step when you find cancer in the spine?

A

CT to look for other cancer (breast, lung, liver)

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5
Q

What is the treatment plan for spinal cord compression with focal neuro findings?

A

steroids: high dose dexamethasone!!!

if cancer - radiation/chemo depending on cancer

may need sugery if need tissue dx, spinal instability

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6
Q

What is the dx in a pt with evolving paralysis and areflexia and no other systemic manifestations?

A

Guillain Barre

(demylinating disease)

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7
Q

How do you dx Guillain barre?

A

LP

Elevated protein, no WBC

dx test is EMG/Nerve conduction velocity

hx of infection (campylobacter), ascending symmetric weakness

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8
Q

How does transverse myelitis present?

A

clear motor and sensory level loss

hyperreflexia below level

loss of anal sphincter tone

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9
Q

How does Botulism present?

A

early loss of pupillary reflexes and CN abnormalities

paralysis is descending

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10
Q

How does Charcot-Marie-Tooth disease present?

A

very slow onset, rarely gets severe

foot drop/weakness or sensory loss stocking distribution

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11
Q

How to manage Guillain Barre?

A

best to get tx w/in 2 wks onset

tx: plasmapheresis or high dose IVIg (both good)

monitor and provide respiratory support, cardiac arrhythmias, autonomic instability

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12
Q

What is the prognosis in Guillain Barre?

A

good - most people full recovery with/in weeks to months

need PT

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13
Q

Ddx for dementia?

A

normal pressure hydrocephalus

chronic subdural hematoma

vit B12 def

hypothyroidism

terytiary syphilis

alzheimer’s dz

psuedodemential of depression

Pick’s dz (frontotemporal dementia)

Lewy body dementia

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14
Q

What is the dx for an elderly pt with dementia, gait ataxia, and urinary incontinence?

A

normal pressure hydrocephalus

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15
Q

How to work up and dx dementia?

A

reversible causes w/u: Thyroid function tests, HIV/AIDS (30-50 yo), Vit B12, CBC, VDRL, Drug screen, depression signs

MRI - shows atrophy and degeneration

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16
Q

How to tx alzheimers?

A

social support (don’t get lost, prevent injury…etc)

Donepezil, rivastigmine, or galantamine (improve memory and slow loss of memory)

Memantine added to cholinesterase inhibitors (above)

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17
Q

How to treat normal pressure hydrocephalus?

A

LP and remove 30-50ml of CSF and symptoms improve!

Place CSF shunt if caught early

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18
Q

What bleeds in subdural hematomas?

A

bridging veins, can be chronic and slow

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19
Q

What bleeds in an epidural hematoma?

A

middle meningeal artery

deteriorate fast after a lucid interval

20
Q

How to manage subdural hematoma that is symptomatic?

A

neuro/neurosurg consult

surgical drainage to relieve pressure on the brain

21
Q

What is the ddx for worst headache of life?

A

subarachnoid hemorrhage

pituitary apoplexy (during difficulty delivery of baby)

migraine

22
Q

What is the w/u for worst headache of life?

A
  1. noncontrast CT!
  2. if negative - LP bc CT is negative ~10% of time

*RBCs will not change (stay high) between CSF tube 1 and 4

  1. could consider CT angiography or MRA (if other 2 are neg and still think it is an SAH, this is the gold standard and will need to be done either way)
23
Q

How do you figure out the cause of a subarachnoid hemorrhage?

A

CT angio

or MR angio

*if first image is negative, do a repeat study a little later

24
Q

What is a significant risk factor for subarachnoid hemorrhage?

A

1st degree relative with subarachnoid hemorrhage (anuerysm)

25
Q

How to tx subarachnoid hemorrhage?

A

ICU, telemetry and electrolyte monitoring, DVT prevention (compression devices, no antithrombotic meds)

  1. neurosurgical consult
  2. surgical clipping and coiling with 48-72 hours
  3. Nimodipine (CCB) for 21 days to prevent post-SAH vasospasma and ischmemia
26
Q

What are complications of subarachnoid hemorrhage?

A

re-bleeding

delayed brain ischemia from vasospasm

hydrocephalus

hyponatremia due to SIADH

27
Q

What is the most common cause of subarachnoid hemorrhages?

A

aneurysm

less common:

cocaine, arterial dissection, AVM, coagulopathy, trauma

28
Q

What is meniere’s disease?

A

chronic vertigo

unilateral hearing loss and tinnitus

comes and goes

29
Q

What is vestibular neuritis?

A

labyrinthitis - inflammation of vestibular neuritis

vertigo, acute, severe, unsteadiness

GI sx: N/V, may last hours

30
Q

How to tx Meniere’s disease?

A

meclizine

salt reduction and diuretics

31
Q

What is a Ddx for seizure with focal symptoms?

A

sz with todd paralysis

stroke w/ sz

AVM w/ sz

brain tumor w/ sz

metabolic cause of sz

cocaine overdose or alcohol/benzo withdrawal

32
Q

How to work up first time sz?

A

electrolytes, glucose, ABG, CBC, UA, tox screen

CT with and w/o contrast or MRI w/ contrast

if meningitic s/sx - LP

33
Q

What is a Todd paralysis?

A

hemiparesis that resolves within hours of sz

34
Q

What could a brain enhancing lesion be?

A

abscess, tumor, lymphoma, toxoplasmosis

35
Q

How to treat seizures that persist/status?

A

A, B, C

IV benzo, benzo

IV forsphenytoin/phenytoin

IV phenobarbital

propofol and intubation

36
Q

How to tx toxoplasmosis?

A

pyrimethamine and sulfadiazine + folinic acid

if ring enhancing lesion in HIV + pt, start tx, then CT in 2 wks, if lesion isn’t responding - further eval (biopsy)

37
Q

How to treat a patient for seizures in adults?

A

phenytoin (load and then daily dose)

levetiracetam, lamotrigine, valproic acid

38
Q

What is the sz med lamotrigine’s dangerous side effect?

A

cutaneous hypersensitivity - stevens johnson syndrome

39
Q

What vitamin must be given if a pregnant woman is on seizure meds?

A

folic acid!!!

most sz meds deplete folate

40
Q

What are the major side effects of phenytoin?

A

cardiac toxciity

hemolytic anemia, nephritis, fever, rash

hirsutism, gingival hyperplasia

41
Q

How to w/u and tx concern for stroke?

A

CT non contrast (hemorrhagic or not)

*can take 24 hrs to show up!

tPA if presents within 3 hoursof persistent neuro findings and no active bleeding

aspirin is > 3 hrs and no a-fib

42
Q

What studies do we need to get for stroke pts while inpt?

A

repeat CT 3 days later

EKG

ECHO

Carotid doppler

24-hr telemety

43
Q

Who should be put on heparin if they have a stroke?

A

only if a-fib present! *be careful, can make the stroke hemorrhagic

44
Q

Is it more common to have an ischemic stroke or a hemorrhagic stroke?

A

ischemic (80%)

hemorrhagic (20%)

45
Q

What are contraindications for TPA in stroke?

A

previous stroke/head trauma w/in 3 months

BP >185/110

recent surgery w/in 2 wks

abnormal PT/PTT

GI/GU bleeding w/in 21 days

PLTS < 10k

coma or stupor

46
Q

What aretery is affected in a stroke with symptoms of aphasia/apraxia (can’t do a learned skill that you could before)?

A

middle cerebral artery

emboli from heart lodge here 80% of time

47
Q

What is the most common source of emboli for embolic strokes?

A

HEART!

a fib, mitral stenosis, vegetations

Step 3 (15 decks)

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