Everything Else - Starred Flashcards by Addie Johanson

Small axons carry what three sensations

Autonomic fibers: light touch, pain and temperature

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Most common complaint of peripheral neuropathies:

Numbness and tingling and the hands and the feet

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Severe long standing neuropathies can lead to:

Ulcers

- Loss of hair and trophic changes *LESIONS

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Peripheral mononeuropathies vs. polyneuropathies:

Mono: CN (bell’s)
Poly: Systemic (Guillain-Barre, DM)

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Who is Bell’s palsy more common in?

Pregnant women and elderly

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What is Bell’s associated with disease wise?

HSV-1, Lymes and Varicella Zoster (presence of lesions too)

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CN 7 palsy PE findings (3):

Cannot close the affected eye
Cannot raise the corner of the mouth on affected side
Loss of nasolabial fold on affected side

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Treatment of mild Bell’s palsy:

Prednisone taper + eye drops

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Treatment of severe Bell’s palsy:

Prednisone taper + eye drops + acyclovir

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Most common form of Guillain-Barre Syndrome:

AIDP: Acute inflammatory demyelinating polyradiculoneuropathy

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Physiology of Guillain-Barre Syndrome:

Following an infection (or other event like pregnancy) - autoimmune reaction with peripheral nerves that causes demyelination

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Most common infection that causes GBS?

Campylobacter jejuni

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Common presentation of GBS:

Symmetric muscle weakness - legs then arms (ascending)

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What are DTRs like in GBS?

They are absent or depressed

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Other symptoms of GBS include:

Autonomic (tachycardia, arrythmias, sweating)

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To diagnose GBS, what three tests do you order?

CSF (elevated protein, normal cells)
Serum IgG
MRI/electrophysiology

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You do not use steroids to treat:

GBS - can delay recovery

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Treatment of GBS:

Plasmapheresis or IVIG

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How long does GBS last?

4 weeks - it has to run its course

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What are Chronic inflammatory demyelinating polyneuropathies?

Like GBS but not as severe - no ICU

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What is Mononeutiris Multiplex?

Form of damage to one or more peripheral nerves - is a syndrome NOT a disease

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Three diseases that can damage nerves and cause Mononeuritis Multiplex?

Diabetes
Vasculitis
CT disorders - RA

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Vitamin B12 is called:

Cobalamin (folic acid deficiency)

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Most common cause of Vitamin B12 deficiency:

Pernicious anemia

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Defining feature of Vitamin B12 def.:

Hyperreflexia with absent achilles reflexes

Antibodies to what two types of cells will be found in someone with pernicious anemia:

Antibodies to: - Intrinsic factor - Parietal cells

Vitamin B12 treatment:

- IV for a week - Dose every week for four weeks - Dose every month for life

If on any of the four drugs, you need a folate supplement:

- Methotrexate - Phenytoin - Trimethoprim - Metformin

Vitamin B12 deficiency produces a megaloblastic anemia (high MCV) and can cause:

Neurological defecits

Vitamin B1 (thiamine deficiency) results in:

Beriberi

Difference between dry and wet beriberi in Vitamin B1 deficiency:

Dry: Symmetrical peripheral neuropathy Wet: Symmetrical peripheral neuropathy + cardiac manifestations

What does thiamine do?

Initiates the nerve pulse that is independent of its coenzyme functions

What does vitamin B6 (pyridoxine) do?

Neurotransmitter synthesis

What two things inhibit Vitamin B6?

- Isoniazid | - Hydralazine

Three characteristics of Vitamin B6 deficiency:

- Seborrheic dermatitis - Glossitis and stomatitis - Microcytic hypochromic anemia

Pellagra (niacin B3) deficiency is commonly seen in:

alcoholics

Two PE findings of pellagra?

- Red tongue | - Red (sunburn) rash on exposed skin areas

Most common cause of neuropathy in the US:

Diabetes Mellitus

Autonomic neuropathies affect 50% of diabetics - Symptoms include:

- GI dysmotility - Cardiac arrhythmias - GU dysfunction (bladder)

Best way to prevent worsening of the diabetic neuropathy:

Glucose control

Treatment for painful Diabetic Neuropathy:

- AEDs (gabapentin) - TCAS - SNRI - Lidocaine, caspacin

Post herpetic neuralgia persists over:

1 month of the resolution of a rash

ABCD2 scoring system for stroke:

``` A: >60 B: BP >140/90 C: (1 speech), (2 unilateral weakness) D: (2 points if over 60 mins) D2: (1 point diabetes) ```

Admit with ABCD score of:

3 or more

Classic definition of stoke:

Ischemic (thromboembolism)

If you are thinking stroke, want a CT without contrast why?

To look for bleeding, not the stroke

What is paradoxus embolus?

Venous embolus through the arterial system (fat or air from surgery)

What are lacunar strokes?

less than 1 cm - endothelial damage from HTN or DM

With ischemia of the vertebral artery you can experience (2):

- Vertigo | - Contralateral body, ipsilateral face loss (sensory)

With Basilar artery problems, what four clinical signs can you have?

- Dysarthria - Hemi/quad paresis - LOC - Ipsilateral gaze deviation (moves away from side of stroke)

If you think someone is having a stroke, what lab must you order?

Glycemic - A hypoglycemia state of 30 can look like a stroke

What is a stroke in evolution?

Worsening in first 24 - 48 hours

NIH stroke scale scoring:

``` 0: no stroke 1-4: minor 5-15: moderate 15-20: moderate/severe 21-42: severe ```

Imaging systems to evaluate the carotids when someone has a stroke:

Carotid duplex ultrasound | *Carotid enderectomy (CEA) is gold standard

If you suspect a Subarachnoid hemorrhage you order a CT stat and a:

Lumbar puncture

Best stroke center acronym:

ACSC

Primary therapy for stroke:

TPA - Thrombolysis (rt-TPA Ateplase)

Inclusion criteria for use of TPA with stroke:

Must be used within 4.5 hours

Want to get IV TPA started under:

60 Minutes

What is endovascular therapy?

Can be used as a proximal treatment when a patient has missed the window for regular TPA

When do you hold aspirin in a stroke patient?

You hold for the first 24 hours if they are having TPA

When should a patient have warfarin instead of ASA? (3):

- A-fib - Prosthetic heart valve - Intra-cardiac thrombi

Is there data with heparin use in stroke?

NO - only for DVT prophylaxis

Target blood pressure for a stoke patient:

<185/<110

Initiate hypothermia in stroke patients for the first:

12-24 hours after a stroke

What medication increases the risk of hemorrhagic transformation?

TPA (Aspirin does not)

Three resin factors for a hemorrhagic transformation:

- Large infarct - Hypertension - Use of thrombolytics/anticpagulants

Treatment for brain edema from a large stroke (2):

1. Diuresis (Mannitol) | 2. Surgery

Most powerful risk factor for stroke:

HTN

Risk factor for stroke with CAD and CHF:

x3 CAD | x4 CHF

What medication do we want a stroke patient on for prevention (3):

- statin (atorvostatin 80 mg) - ASA + dipyridamole - BP/DM control

After a stroke you can restart BP drugs after:

24 hours

all patients should be referred to what after a stroke?

PT, OT, Psych, social workers

Who is most at risk demographically for a stroke, who dies?

- AA x2 (AA males 45-54 x3) | - Women die from stroke more than men - they do not have a higher risk for CA

Genetics to predispose to intraparenchymal hemorrhage:

APOE E2 and E4 - amyloid deposition

Causes of intrapenchymal hemorrhage (4):

- Cerebral amyloid antipathy - Vascular malformations - Drugs (cocaine/meth) - Anticoagulation therapy (warfarin)

What has headaches related to stoke and what does not?

Interparenchymal hemorrhage has a HA 50% of the time, ischemic strokes do not have HA

Assume what in someone with intraparenchymal hemorrhage?

C spine injury - keep at 30 degrees and maintain euvolemia (CVP 5-12)

If seizures post stroke, what do you prescribe?

Phenytoin

Blood pressure ranges post stroke:

1. HTN <130 2. Post-op <110 3. DON'T let anyone below 90

Subarachnoid hemorrhage caused by (cause 5-10% of all strokes):

Saccular/berry aneurysm (80%)

PE findings with someone SAH (4):

- Flame hemorrhages in the eye - Thunderclap, worse HA ever - Complaint of previous sentinel HA - Nuchal rigidity

What are you looking for in the CSF with someone that has SAH?

Xanthocromia (hemoglobin break down of blood)

What can you do to treat the SAH (5)?

Clip, coiling, nimodipine, BP control (100-110)

Complications of SAH (4):

- Vasospasm** - Hyponatremia - NOT SIADH - Neurogenic cardiac stunning - Hydrocephalus

How do you treat vasospasm after SAH (can cause stroke 14-20%)?

Triple H: Hypertension (induce with pressers), hypervolemia, and hemodilution

SAH two defining characteristics from ischemic and intraparenchymal findings:

- Worse HA of my life | - decreased LOC

What is a sentinel HA?

Before a SAH and rupture - get CT and LP to check

Most common roots for PHN

T4-6

Complex regional pain syndrome affects ___ from the site of damage

Distally

PE findings of CRPS

Skin changes, nail changes, vascular abnormalities, joint stiffness

Treatment of CRP2/1

Opioids, prednisone, NSAIDS

Everything Else - Starred Flashcards

(92 cards)