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Block 3: Neuro > Clin Med: Neuro I > Flashcards

Clin Med: Neuro I Flashcards

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1
Q

3 “headache” populations

A
  • Outpt office- usually migraine or tension
  • ER–> must immediately exclude life threatening headaches
  • Headaches during pregnancy
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Q

To differentiate a HA from brain bleed use…

A

RED FLAG SYMPTOMS

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Q

SSNOOP criteria to ID red flag symptoms

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  • Systemic symptoms
  • 2ndary risk factors/underlying dz (HIV, cancer)
  • Neurologic signs/symptoms (confusion, focal neuro findings)
  • Onset (sudden, abrupt)
  • Older age (new onset/progressive)
  • Pattern change (change from previous is frequency or severity)
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4
Q

Primary HA examples

A
  • Migraine
  • Tension
  • Cluster
  • Other (cough, exercise, post coital)
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5
Q

2ndary HA examples

A
  • Trauma
  • Vascular (TIA, CVA)
  • Substance or substance withdrawal
  • Infx (meningitis, influenzas)
  • Disorder of homeostasis (HTN, altitude, sleep apnea/hypoxia)
  • Attributed to disorder of eyes, ears, sinuses, teeth
  • Psychiatric Disorder
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6
Q

Painful Cranial Neuropathies/Facial Pain Examples

A
  • Trigeminal neuralgia
  • Optic neuritis
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8
Q

What is considered an episodic tension HA?

A

14 or less per month

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Cluster HA Dx
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abortive therapy for cluster HA
- First line--> 100% O2 high-flow mask w/ pt in sitting position --> 10-20 minutes - triptans
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Prophylactic therapy for cluster HA
- Verapamil - **Lithium**
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"Other" Tx for Cluster HA
- Suboccipital corticosteroid injections in the greater occipital nerve - Prednisone for 5 days post-attack - Galcanezumab (Emgality)
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Describe a cough induced HA
usually only lasts a few mins after coughing. Last just a few secs or mins
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Describe an exercise - induced HA
can last up to a few hrs after strenuous exercise
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Describe a post-coital HA
A sudden, severe, throbbing HA that occurs just before or at the moment of orgasm
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Define Multiple Sclerosis
Demyelinating disease of the CNS
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What age group has relapsing & remitting MS?
25-29yo
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What age group has primary progressive MS?
39-41yo
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MS is more common in which gender?
women
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MS risk factors
- Low UV light exposure (living in northern latitudes, ?Vit D) - Smoking - Obesity
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MS pathophys
demyelination occurs when the immune system inappropriately causes B & T cells to attack & destroys myelin, causing inflammation which leads to more immune response & more inflammation
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MS S/S:Hx
- **Optic neuritis** - limb weakness - numbness, feelings of pins & needles - urination or BM problems - vision problems - impaired vision, pain w/ eye movements, double vision, or jerking sensation in visual field - gait impairment
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MS PE: focal spinal cord inflammation
- any form of paresis - flaccid muscle tone - reduced/abnl sensation
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MS PE: oculomotor exam
- disconjugate eye movements - nystagmus
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MS PE: brainstem, cerebellum, or cerebral dysfunction
- dysmetria on finger-to-nose testing - intentional or postural tremor - facial paresis or hypoesthesia - dysarthria - dysphagia - cognitive impairment
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What features are suggestive of MS?
- relapses & remissions - onset b/t 15-50yo - optic neuritis - Lhermitte sign - Internuclear ophthalmoplegia - fatigue - heat sensitivity (Uhthoff phenom)
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MS diagnosis requires
involvement of **≥ 2 areas** of CNS (dissemination in space) at different time points (dissemination in time)
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MS Dx Labs
- CBC - ESR/CRP - LFT - BUN/Cr - Ca++ - glucose - thyroid function - vit B12 deficiency, - HIV
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What will MRI show for MS?
lesions
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What will CSF analysis show for MS?
oligoclonal bands (IgG)
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MS acute episode, including relapse Tx
- dexamethasone - methylprednisolone
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MS 1st line tx for relapse prevention
- Glatiramer acetate (Copaxone) - Interferon B-1b (Betaseron)
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Define Myasthenia Gravis
An autoimmune disorder affecting the NMJ
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How will a patient present w/ Myasthenia Gravis?
painless, fluctuating weakness of muscle groups & often begins w/ ocular s/s (ptosis & diplopia).
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Myasthenia Gravis: gender prevalence
< 50yo, 3x more common in females > 50yo, initial dx slightly more males
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Myasthenia Gravis is assoc. w/ what other autoimmune disorders?
- Thyroiditis - SLE - RA
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What can occur in 15% of pts with Myasthenia Gravis?
Thymoma
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Myasthenia Gravis pathophys
Autoimmune so, body thinks something is wrong w/ the ACh receptors--> body creates autoantibodies that block the ACh receptors--> ACh can’t bind--> causes muscle weakness
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Myasthenia Gravis: S/S&Hx
- ocular weakness **asymmetric ptosis & diplopia** - Dysarthria (difficulty speaking) - change in voice - trouble chewing - dysphagia - weakness & fatigue progress throughout day & worsen w/ activity
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Myasthenia Gravis: PE
- check for muscle weakness & fatigability - impaired eye muscles (extraocular muscles) [painless asymmetries] - **Orbicularis oculi** weakness, ectropion, or "peek" sign - cranial nerve examination
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Myasthenia Gravis: neuro exam findings
- asymmetry pattern of weakness of extraocular muscles not involving the same nerve - **normal pupil function** - try to elicit ptosis
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Myasthenia Gravis: Dx
- Acetylcholine receptor (AChR), muscle-specific tyrosine kinase (MuSK), or lipoprotein receptor-related protein 4 (LRP4) antibodies - EMG--> nerve will eventually fatigue & not respond to stimuli - edrophonium chloride (Tensilon) test resulting in unequivocal resolution of weakness - CT chest--> thymus tumor?
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Acetylcholinesterase inhibitors - Pyridostigmine - Neostigmine
Acetylcholinesterase inhibitors - Pyridostigmine - Neostigmine
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How do Acetylcholinesterase inhibitors work?
Prevent the breakdown of Ach in the NMJ--> incr chance of ACh getting on receptors that aren’t blocked
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In Myasthenia Gravis ___ can be given w/ exacerbations & severe dz?
Immunoglobulins
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What tx meds can lessen autoimmune rxn in Myasthenia Gravis?
- Corticosteroids - IVIG - plasma exchange
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Myasthenia Gravis requires what tx?
intubation & ICU admit
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In Myasthenia Gravis, __% of people will have ____ w/n ____ of ill
- 25% - resp failure - first year
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Define Delirium
- caused by acute illness or drug toxicity (sometimes life threatening) - often reversible
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I WATCH DEATH mnemonic
I - Infx (UTI, pneumonia, encephalitis) W - Withdrawal (ETOL, benzos, sedative-hypnotics A - Acute metabolic (ETOL T - Toxins (opioids, steriods, anticholinergics, psychotropics) C - H D - Deficiencies (thiamine w/ ETOL, B12) E - Endocrine (thyroid, hypo/hyperglycemia, adrenal insuff) A - Acute vascular (shot, HTN enceph) T - Trauma H - Heavy Metals
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What is the most common form of dementia?
Alzheimer's Dz
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Define Dementia
acquired deterioration in cognitive abilities resulting in decrease in ADLs
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Dementia (all forms) Non-pharm approaches
- structure and routine - no nonessential drugs - Exclude unrecognized delirium, pain, urinary obstruction, or fecal impaction - Caregivers speak simply to the patient, break down activities into simple component tasks - Aerobic exercise (45 mins most days/week) & frequent mental stimulation
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Alz (Dementia) Pharmacologic Tx
- Cholinesterase inhibitors for functional impairment - NMDA receptor antagonist for cognitive ability
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Alz Vascular (Dementia) Tx
- Control RFs for stroke - Cholinesterase inhibitors for functional impairment - NMDA receptor antagonist for cognitive ability
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Dementia w/ Lewy Bodies Pharmacologic Tx
- Cholinesterase inhibitors - Antipsychotics for behavior changes - Benzos for sleep disorders
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Frontotemporal Dementia Tx
Antipsychotics for behavior changes

Block 3: Neuro (10 decks)

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