CNS Flashcards
(153 cards)
1
Q
A fib can lead to..? What is cx called?
A
stroke
emoblic stroke
2
Q
Pt has HA + slurring speech + facial droop? What lab to order?
A
cerebral ischemic stroke
lab: CT ASAP
+/- syphillis
3
Q
What is the timeline for TPA in ischemic stroke?
A
4.5hrs
4
Q
How to tx ischemic stroke if after 4.5hrs?
A
ASA
clopidigrel
5
Q
Pt has curtain like blindness 30min ago but now it’s ok? What was that sx called?
A
transient ischemic attack
Amaurosis fugax
6
Q
How to tx transient ischemic attack? What to be worried about?
A
ASA
pt has high risk of stroke in couple months
7
Q
Pt has dsyarthria and clumsy hand? What is cx and how to tx?
A
lacunar stroke-internal capsule
cx: thrombosis
tx: self limiting
8
Q
Pt is oddly looking at your from his right side and has difficulty talking? What is the sx called? What other sx to expect? How to tx?
A
posterior cerebral artery
sx: ipsilateral gaze, contralateral hemiplegia
other sx: dysarthria, aphasia
tx: ASA
9
Q
Pt has dysarthria-ddx?
A
lacunar stroke and middle cerebral artery stroke
10
Q
Pt has posterior cerebral artery - what to expect on eye exam?
A
3rd nerve palsy- eye is dilated and not reactive to light; eye is out and downward; lid is closed
11
Q
Pt has blindness, altered mental status? Tx?
A
distal posterior cerebral artery
tx: ASA
12
Q
What strokes are tx’d with ASA?
A
ischemic stroke that is over 4.5hrs
TIA
posterior cerebral artery
distal posterior cerebral artery
13
Q
What is a RF for BOTH ischemic and hemorrhagic stroke?
A
HTN
14
Q
What are the main sx for hemorrhagic stroke? What are main tx?
A
signs of increased intracranial pressure- HA, vomiting, papilledema
tx: reduce HTN, mannitol, diuretics
15
Q
Pt has pin point pupils?
A
intracerebral hemorrhage - pons
16
Q
Pt has poorly reactive pupils?
A
intracerebral hemorrhage - thalamus
17
Q
Pt has dilated pupils?
A
intracerebral hemorrhage- putamen
18
Q
What is the main cause for a hemorrhage stroke in adults? young adults?
A
adults: age
young adults: cocaine
19
Q
Where is the most common area for cerebral hemorrhage? PE?
A
putamen
PE:dilated pupils
20
Q
Pt has sensory defect + phasia + visual defect?
A
thalamic
21
Q
Pt has decerebrate + dolls eyes?
A
pin point
22
Q
Pt has occipital HA + gait ataxia?
A
cerebellar
23
Q
Pt has focal HA + vomiting?
A
lobar
24
Q
How do you expect pt to describe “worst HA of my life”? Gold standard? Tx?
A
subarachnoid hemorrhage
angio is gold standard
surgical clipping/endovascular coil
25
Pt brings in baby by intermittent explosive disorder mother - what to expect in eye of baby? What to expect on CT?
acute subdural hematoma
blow pupil
CT: CRESCENT shape
26
How to tx acute subdural hematoma?
burr hole drainage
| craniotomy
27
Pt lives alone and daughter says grandma isnt acting the same; more forgetful and drowsy - how to tx?
chronic subdural hematoma
| tx: watchful waiting
28
Pt was skateboarding and hit his head (not wearing a helmet); brought in by friends and says he lost conscious but now he's back- what to expect on PE? What is best next step?
epidural hemorrhage
PE: fixed, dilated pupil
next step: CT and find ROUND hematoma (b/c it is near the sutures and cannot pass it unlike subdural is under sutures and spreads)
29
What phases to epidural hemorrhage pts go under?
unconscious -> lucid interval -> coma
30
How to tx epidural hemorrhage?
surgery and control bleeding
31
What is the pathophys behind epidural hemorrhage?
laceration of middle meningeal artery + skull fx
32
Pt comes home from school and complains of pulsating noise in head? What imaging study? How to tx?
av malformation
MRI >CT
tx: surgery, embolization, stereotactic radiation
33
Which pts are at risk for moyamoya dz and what to expect on imaging?
japanese, native americans
| puff of smoke
34
What is the pathophys of moyamoya dz?
small stenosis occurs forcing new collateral circulation in brain
35
What are sx of ICP?
```
HA
seizures
vomiting
papilledema
cushing triad
```
36
What is cushing triad?
increasing BP
falling pulse
widening pulse pressure
37
What are sx of parkinsons?
```
pill rolling tremor
mask like face
shuffling gait
trouble initiating first step
lack fo arm swinging w/arm
later: behavioral changes, dementia
```
38
What dementia is related with parkinson?
lewy body
39
What is the pathophys behind parkinsons?
death of the cells in substantial nigra of the basal ganglia
40
What are PE you have pt do to help dx parkinsons?
rigitidy/cogwheel
| bradykinesis
41
How to tx parkinsons-first line? What does this drug target?
benztropine
| target: tremors
42
What drug should be used as last resort for parkinsons?
leveodopa/carbidopa
43
Pt just graduated from college and got a new job but having complaints of attitude problems at work and having trouble walking? What to watch out for in this pt?
huntington
| pt have high risk of suicide-counseling is needed
44
What type of motor/movement skills prob does Huntington have?
chorea
45
What is the pathophys behind Huntingont's?
loss of GABA producing neurons
46
Pt has trouble eating with chopsticks - type of tremor? What makes it better?
essential tremor
| better: ETOH
47
Pt has trouble writing name? Is this bilateral or unilateral? tx?
essential tremor
bilateral
tx: propranolol
48
What kind of genetic dz is Huntington?
autosomal dominant
49
What drugs may cause parkinson?
neuroleptic drugs - haloperidol (tourette)
50
What is the timeline for tourette?
```
5yo - blinking
7yo - snorting, shrugging
14yo - head shakes, phonetic
19yo - subtle head shake + abdominal tensing
*gets better w/age
```
51
What is tourette associated with?
OCD
52
How to tx tourette?
haloperidol
53
Pt's wife says that husband keeps kicking her in bed and husband is feeling fatigue? What to find on PE? What is best next step?
restless leg syndrome
PE: NORMAL neuro exam
next step: check serum ferritin (would be low) for anemia
54
What is criteria for restless leg syndrome?
urge to move legs
worse at night
creepy-crawling sensation that improve w/ movement
55
Tx for restless leg sx?
lifestyle changes
| dopamimetics, gabapentin
56
Pt has bipolar dz that has been improving and now has smacking lips probs? Cx? Tx?
tardive dyskinesia
taking dopaminergic antagonist
remove drug
57
What is a strong correlation with dementia?
anticholinergics
58
What are some drugs for dementia?
donepezil - cholinesterase inhibitor
| memantine - neuropeptide modifier/glutamine blocker
59
What are ddx of dementia?
- primary neurologic disorders?
- infwn?
- metabolic?
- drugs?
- mood?
- tumor
- HIV/neurosyphilis; Creutzfeldt jakob
- thyroid dz; vita B12 def; thiamine def
- alcoholism
- pseudodementia (depression)
60
Pt has HTN + atherosclerosis - highest risk for which dementia?
binswanger dz
61
Pt has vascular dementia- what to expect on PE?
hemiparesis
unilaterla babinski
visual field defect
62
Pt has B1 def? Seen in who? Reversible?
wenicke
alcoholics
reversible w/thiamine
63
Pt has CHRONIC vB1 def? Seen in who? Reversible?
korsakoff sx
alcoholics
NOT reversible
64
What type of dz is Creutzfeld-Jakob? PE?
prior dz
| rapid progressive demenia
65
Pt has hallucination? What is this associated with?
Lewy body
| parkinson
66
What are cxs of delirium?
```
P. DIMM WIT
P-ostoperative state
D-ehydration
I-nfxn
M-eds
M-etals
W-ithdrawal
I-inflammation
T-rauma
```
67
What is delirium?
ACUTE period of cognitive dysfxn
68
Pt is in high school and is in dancing club but starting to feel numbness in toes and having trouble with bladder? What other sx would pt have? What PE would be positive?
multiple sclerosis
Uhthoff - worse sx when in hot temp
sx - vision changes: optic neuritis, tremors, fatigue
Lhermitte - when pt head is flexed there is electrical sensation that runs down back into limb
69
What labs to run for MS?
CT to check for plaques in lateral ventricles
| oligoclonal banding; more proteins
70
What is MS?
autoimmune that results in demyleination of axon
71
What are the different phases of MS? What is each defined?
relapsing remitting- episodic, never return to baseline, worse sx w/ every episode
secondary progressive - starts off as relapsing but turns into primary progressive (never getting better/not episodic)
primary progressive - not episodic - always getting worse
progressive relapsing -episodic and progressively getting worse
72
What is NOT typical for MS?
```
50 yo
cortical deficits (alexia, agraphia, apraxia, aphasia)
seizures
early dementia
rigidity (basal ganglia)
```
73
How to tx MS?
```
nothing - DMT (Dz modifying therapy)
-does not reverse sx, resuce acute MS relapses, slow dz
acute? - HD, short corticosteroids; plasma exchange
Beta interferons (pallative)
Vita D (doesn't hurt to give em; may reduce relapse if it works)
OT/PT (to make them more functional)
```
74
Pt had pneumonia and now has weakness in legs and arms? What to expect on PE? What sx can this dz lead to? What labs?
guillain barre sx
generalized paralysis - resp arrest
PE: DTRs are GONE
CSF: high protein after 14days but normal ct
75
What is guillain barre? CLASSIC sx?
autoimmune demylinating poly neuroapthy
| ASCENDING weakness/paralysis - rubbery legs
76
What is MAIN cx of guillian barre (bug)?
campylobacter jejuni
77
How to tx guillian barre?
+/- vent support
| plasmapheresis IVIG
78
Pt says that eyes are extremely tired by the end of the day and cannot keep them open? What vision prob will they complain of?
myasthenia gravis
ptosis
diplopia
blurred vision
79
What is the pathophys behind myasthenia gravis and who do you see this in?
autoimmune dz
| women; 20-3yo
80
What is a medical emergency found in pts with myasthenia gravis?
diaphragm and intercostal fatigue (muscles that are used ALL THE TIME) - respiratory prob
81
What must be r/o in myasthenia gravis? How can it be r/o?
thymoma
| CT
82
Are the DTRs preserved in myasthenia gravis?
yes
83
Myasthenia gravis tx?
long acting anticholiesterase
| immunosuppresion
84
How to differentiate between myasthenia gravis and lambert eaton myasthenic syndrome?
LEMS has DEPRESSED/ABSENT reflexes
85
Child has progressive SYMMETRIC muscle weakness? PE?
Duchenne's muscle dystrophy
PE: 1) gower's - not able to get up without using hands
2) calfs are big then weak
86
How to dx duchenne's muscle dystrophy?
muscle bx
87
Tx for duchenne's muscle dystrophy?
prednisone
88
What is duchenne's muscle dystrophy?
X linked
89
What is becker's muscle dystrophy?
like duchenne but less severe and later onset
| BOTH: x linked
90
What is lambert eaton myasthenic syndrome usually associated with?
small cell lung carcinoma
91
Pt has cafe au lait spots and rubbery cutaneous tumors? How to dx?
neurofibromatosis
| bx
92
What are the autosomal dominant neurocutaneous syndromes?
neurofibromatosis
| tuberous sclerosis
93
Pt has cutaenous lesions, brain tumors, mental retardation and is dx by CT?
tuberous sclerosis
94
Pt says "theres a pebble stuck in my shoe"? Where does it occur?
morton's neuroma
| metatarsal head @ 3rd and 4th toe
95
How to dx morton neuroma and tx?
dx: MRI
tx: change shoe, CS, excise
96
Pt has Brown sequard syndrome - what is lost on contralateral and ipsilateral side? What are teh tracts?
pain and temp on CONTRALATERAL - spinoathalamic
| position and vibration - dorsal column
97
What is associated with pancoast tumor? What are PE?
horner's syndrome
| PE: ipsilateral ptosis, miosis, anhidrosis
98
What are the 2 types of vertigo?
benign positional vertigo
| meniere dz
99
What is the triad of menieres dz?
vertigo
tinnitus
hearing loss
100
What is PE of BPV?
only CERTAIN positions trigger veritgo
101
How to tx BPV?
meclizine
102
Pt has fears of needles and passes out?
neurally mediated vasovagal
103
Pt was defecating and passes out?
neurally mediated situational reflex
104
What are PE that BOTH vasovagal and situational reflex neurally mediated syncope have? How to tx?
prodromal phase
- diaphoretic
- pallor
- palpitation
tx: supportive
105
What is the prob with neurally mediated vasovagal?
ANS is going out of control
| INCREASE of parasympathetic
106
What is the difference between volume depleted and neurogenic orhtostatic syncope?
volume depleted has decrease w/in 15sec + COMPENSATORY HR
| neurogenic orthostatic syncope has decrease of 20systolic and 10diastolic in 3min + NO compensatory HR
107
What are primary and secondary cxs of neurogenic orthostatic syncope?
primary - parkinsons, alzheimer
| secondary - DM, amyloidosis
108
Dx neurogenic orthostatic syncope?
tilt table testing
109
How to tx orthostatic syncope?
pseudoephederine
caffeine
NSAID
BRING UP BP
110
What are 2 causes of cardiogenic syncope? PE?
1) structural
2) arrhythmias
PE: SOB, palpitation
111
How to tx cardiogenic syncope?
brady: pacemaker
tachy: defib
strucutral: surgery
112
Pt is conscious during seizure? Tx?
simple partial seizure
| tx: carbamezeprine, phenytoin, iamotrigine, topiarmate
113
What are PE of simple partial seizure?
jacksonian march - starts small but moves to bigger muslce areas
todd: local paresis
114
Pt is unconscious during seizure? Tx?
complex partial seizure
| tx: carbamezeprine, phenytoin, iamotrigine, topiarmate
115
Child is "staring off" in class? Tx?
absence/petit mal seizure
| tx: ethosuximid
116
Pt has muscle contractions + ictal cry -> contract relax -> regains consciousness+ incontenience? What are the phases called? Tx?
generalized tonic-clonic seizure/grand mal
tonic, clonic, post-ictal
tx: levetiracteam(Keppra)
117
Pt keeps bobbing head? Risk?
atonic seizure
| risk: head injury
118
What is associated with myoclonic seizure?
metabolic disorders
anoxic brain injury
CNS dz
119
How to dx fake seizure from real?
EEG
120
What is status epilpiticus?
lasting 5-30 min without returning to baseline
| more than 2 unprovoked seizures
121
Pt ran out of carbemezapine? What is bad about it?
generaliezd status epilepticus
| bad: irreversible neuronal damage
122
Pt has muscle weakness and noticed having trouble buttoning shirt? What to expect on PE?
amyotrophic lateral sclerosis - Lou gehrig
| PE: loss of DTR but sensory intact, NO pain
123
How to dx amyotrophic lateral sclerosis?
increase in serum creatinine kinase
| MRI
124
How to tx amyotrophic lateral sclerosis?
supporitve
125
How to differentiate between wernicke and broca?
wernicke- parrot: able to repeat but does not understand
| broca - cannot talk but understands words
126
Pt suddenly has loss of one sided facial motor fxn? Tx?
bell's palsy
| tx: supportive
127
Pt has herpes zoster - what to be on the look out for? Where to look? Tx?
ramsay hunt
look in ear
Tx: antivirals
128
Pt has PAIN on face? PE? Tx?
trigeminal neuralgia
NO sensory loss
tx: carbamazepine, pheyntoin
129
What dz have sensory in tact on face?
bell palsy
| trigeminal neuralgia
130
Axon or demylination can be recoverd?
demylination
131
Small or large - pain, burning? - numbness, pins and needles?
pain - small
| pins and needles - big
132
Pt has fever + nuchal rigidity + change in mental status + HA?
bacterial meningitis OR encephalitis
133
What are the bugs for infants - bacterial meningitis?
e coli
beta hemolytic strep (Group B)
listeria monocytogenes
134
What are the bugs for children/adults - bacterial meningitis?
S penumo
N minigitidis
h influenza
135
What are PE for meninigitis?
brudzinki neck sign - lift the head and the knee lifts too
kernig sign - lift the leg up but the knee cannot extend
ICP - papilledema
136
Who are at risk for bacterial meningitis?
army
| college dorms
137
How to dx meningitis?
CSF analysis
138
How to tell between bacterial and aspetic meningitis?
CSF analysis
| bacterial: higher WBC, higher proteins, less glucose- bacteria eat sugar and poop proteins
139
What is important to get before tx meningitis?
ALWAYS GET BC BEFORE GIVING ABX!
140
What might be associated with meningitis?
encephlaitis
141
How to tell between meningitis and encephalitis?
CSF analysis!
bacterial meningitis vs viral: high WBC + protein, low glucose
if trying to differentiate between viral and encephalitis - get a CSF PCR THEN MRI
142
How to tx encephalitis?
supportive
143
What are the different viral encephalitis?
herpes simplex encephalitis
cytomegalovirus encephalitis
HIV
144
Pt has rapid progressive dementia? Types?
prion dz
- creutz jakob (mad cow)
- kuru (from eating brain)
- scarpie (in sheep)
145
What are AIDs pts at risk for -infxn in the brain?
fungal dz
146
Pt has TB and back pain? Imaging? Tx?
epidurla abscess -secondary
CT/MRI
medical emergency - drain + IV Abx
147
Pt has severe sinusitis + AOM, at risk for? Dx and Tx?
subdural abscess OR brain abscess- bacterial infxn from sinus/middle ear
MRI-abscess
surgery and IV abx
148
Pt with syphilis or lyme dz is at risk for what CNS infxn?
tabes dorsalis
149
What are sx for tabes dorsalis?
loss of vibration
150
Pt went swimming in warm lake are at risk for what infxn? Bug?
primary amoebic meningoencephalitis (PAM)
| bug: naegleria floweri
151
Pt has diplopia and DESCENDING flaccid paralysis + alert and oriented? Tx?
botulism
tx: close monitoring with respiratory support
+/- antitoxins
152
What is botulism?
gram positive
| toxin blocks Ach release
153
What are the classifications for botulism?
food borne
wound
intestinal - infants w/ honey
