Final (lectures 1-18) Flashcards by Jake Evans

If you see an EEG that shows centrotemporal spikes, which abnormality should you think of?

Benign rolandic epilepsy

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If you see a 3cps(HZ) spike and wave on the EEG, which disorder should you think of?

Childhood absence seizure

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What is the key finding with infantile spasms?

Hypsarhythmia. (This is a high voltage disorganized pattern on EEG)

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what is the difference between an acute and chronic upper motor neuron syndrome?

ACUTE: flaccidity, hyporeflexia, diminished dexterity and hemiparesis.

CHRONIC: spasticity, hyperreflexia, diminished dexterity and hemiparesis.
(Note that acute looks a lot like lower motor neuron defect)

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what is one key way to determine if a spinal cord lesion is extramedullary or intramedullary?

1 pain telling you its extramedullary (painful lesions usually originate from bone)

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what is the number one reason for optic nerve disease?

glaucoma

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Cranial nerve 3 ischemia affects? an aneurysm compressing cranial nerve 3 would cause what?

1) ischemia of CN 3 usually results in death of central nerve fibers. Pupil is normal
2) compression usually results in death of peripheral nerve fibers. Pupil is dilated.

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what is the main cause of emboli going to the brain?

Heart due to atrial fibrillation

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T/F the use of tPA doubles the odds of a favorable outcome in selects patients?

True but remember you only give tPA to certain people with low bleeding risks.

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Hemorrhagic strokes are generally caused by what?

hypertension (often affects the deep areas of the brain)

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what is the gold standard (first line) for treating parkinsons disease?

give LEVODOPA with carbidopa.

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what is the first line treatment for chorea? (2)

Dopamine blockers such as Haloperidol or

Dopamine depleters such as tetrabenazine

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what is the first line treatment for an essential tremor? (2)

1) beta blockers

2) anticonvolsants

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What is the first line treatment for aborting migraine headaches?

“TRIPTANS” (ex: sumotriptan)

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If you have a patient with a headache that is always worse in the AM, what is it? what test will you do first?

1) Tumor/mass

2) MRI (this is unique)

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what do you give for prevention of cluster headaches?

calcium channel blockers such as verapamil.

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what do you give for aborting a cluster headache?

Oxygen first but if this doesnt work give a “triptan”

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Which 1st line drugs should be given prophylactically to prevent migraine headaches? (2)

Beta blockers and TCA’s

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What is required to reduce rebound headaches after using abortive medications?

Patients need to have abortive-drug free days to avoid/reduce the rebound headaches.

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which type of seizure always occurs in those with developmental abnormalities?

Generalized atonic seizures

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which type of seizure is this describing; sudden generalized muscle jerks, occur singly or in clusters, impaired consciousness, NO post-ictal confusion?

Generalized myoclonic seizure

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which type of seizure is often induced by hyperventilation?

Generalized absent seizure

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Which type of seizure ALWAYS ends up as a generalized tonic-clonic seizure when it generalizes?

Partial seizures with secondary generalization; so they would be called (Partial secondary generalized seizures)

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At what age is epilepsy most common? what causes it?

Epilepsy is most common in the elderly and it is usually caused by vascular problems

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Seizure recurrence is favored by? (3 things)

1) An abnormal EEG 2) Family History of epilepsy 3) Lesion on MRI

when can you stop seizure medication use?

You should consider withdrawal of seizure medications if seizure free for at least 2 years.

which anti-epileptic drug is used for both focal and generalized seizures and has very low side effects?

Levetiracetam (Key drug!)

Which drug is best (1st line) for childhood absent seizures?

Ethosuximide

What is SUDEP? How do you best treat it? who is most likely affected?

1) Sudden unexpected death in Epilepsy 2) Best prevented by optimal seizure management 3) adolescents/young adults (mainly males)

when treating status elipticus, what is the first line treatment? If giving glucose, what else should be given?

1) larazepam to stop the attack | 2) Glucose + thiamine always given together

what is 1st line treatment for guillan barre syndrome?

1) plasma exchange and IVIG | 2) ventilation (machine) if FVC is

what are the sequence of events for a patient suspected of meningitis? What do you do if the patient has increased cranial pressures?

1) lumbar puncture followed immediately by antibiotics | 2) antibiotics first, CT next, and when safe do LP

what are the 4 main clinical signs of meningitis?

1) Headache 2) Fever 3) Stiff neck 4) Confusion

T/F Early meningitis is always manifested in the CSF?

False, there are some cases (10%) that show normal CSF

which 3 things allow for infection from encapsulated bacteria?

1) Antibody deficiency 2) Asplenia 3) Complement defect (key here = neisseria)

With a T cell defect, which organism types would you suspect? (general)

1) intracellular bacteria 2) fungi 3) viruses

T/F If you find that a patient has encephalitis, you should consider that patient to have encephalitis due to HSV? What are 2 other common viral causes?

1) True. It is very treatable with acyclovir so give it, and it is one of the most common causes of encephalitis 2) Enterovirus and west nile virus

what must be present to make a sure diagnosis of Guillain barre syndrome?

Areflexia must be present

If you have a person with both UMN and LMN lesions but have no sensory, bowel, or bladder problems, what is the diagnosis?

ALS (Also note that CN's 6, 4, and 3 are always spared)

what are 2 key signs that PE findings that point to ALS?

1) atrophy of the first interosseous muscle | 2) atrophy of the tongue with fasiculations

What do you give a patient with dementia with lewy bodies?

NOT antiphychotic meds! | Give them SSRI's

what are the 3 key lesions you should expect with a ring enhancing lesion in the brain?

1) metastasis 2) Primary tumor in brain 3) abscess

which type of joint disease gets better with movement? gets worse?

Better with movement= inflammatory conditions | Better with rest= non-inflammatory conditions

T/F "tenderness is not arthritis, swelling is arthritis"?

True

which disease has these characteristics; 1) severe aching, stiffness in the neck, shoulder girdle, and pelvic girdle? 2) what other disease is this associated with?

1) polymyalgia rheumatica | 2) Giant cell arteritis

what is arthralgia? arthritis?

arthralgia=joint pain | arthritis=joint swelling

what are the time limits for acute, subacute, and chronic joint pain?

``` acute= hours to days subacute= days to 6 weeks ```

To be diagnosed with giant cell arteritis you need 3/5 of the following which are? (the 5 things)

1) age >50 2) Headache 3) ESR >50 4) Abnormal temporal artery biopsy 5) Temporal a. abnormality (Ex: tender or decreased pulse)

which 2 antibodies are frequently seen in wegeners granulomatosis?

``` Proteinase 3 (confirmatory) C-ANCA ```

which 2 antibodies are frequently found microscopic polyangitis?

1) P-ANCA | 2) myeloperoxidase

T/F classical findings for PAN include multiple stenosis with post stenotic aneurysms?

True

what are the three mimicks of vasculitis?

1) HIV 2) coagulopathy 3) cancer

Which 3 forms of vasculitis do not have ANCA?

1) PAN (poly arteritis nodosa) 2) GCA (giant cell arteritis) 3) Henoch schonlein purpura

which organ system is usually not involved in PAN? Which 3 systems usually are involved with PAN?

1) lungs | 2) abdomen, kidneys, neuologic

which 3 forms of vasculitis DO HAVE + ANCA?

1) Wegeners (C-ANCA, Protienase 3) 2) microscopic polyangitis (P-ANCA, myeloperoxidase) 3) Churg strauss syndrome (P-ANCA, myeloperoxidase)

list the 4 classical manifestations of henoch shonlein purpura?

1) Puprura 2) abdominal pain 3) renal involvement 4) arthritis/arthralgia

what are the 4 major signs of osteoarthritis?

1) non uniform joint spacing 2) osteophytes (must be present) 3) subchondral sclerosis 4) subchondral cysts

what are the 4 major signs of general R.A.?

1) osteopenia (bone loss) 2) uniform joint space narrowing 3) erosion 4) subluxations

what are the 4 key findings for RA in the cervical spine?

1) dens erosion 2) Atlanto-axial subluxation 3) Subaxial subluxation 4) cranial settling

what is causes bamboo spine?

bamboo spine is fusion of the spine in ankylosing spondylitis due to syndesmophytes growing together and eventually fusing. You also see squaring of the vertibral bodies.

what disease has "lumpy bumpy" deposits in the soft tissue around small joints with bone destruction?

Gout. These deposits or called tophi and are made of monosodium urate crystals.

T/F Medication can stop or even reverse the process of Osteoarthritis?

False, meds only alleviate symptoms and increase functionality.

what are the 6 major joints involved in osteoarthritis?

DIP, PIP, 1st CMC, hip, knee, spine | just remember MCP is not affected

which lab tests are abnormal in fibromyalgia?

None.

what are the 3 key characteristics for fibromyalgia?

1) chronic musculoskeletal pain 2) many tender points on body 3) normal lab tests

what are the 3 goals we want to achieve with fibromyalgia?

1) education 2) aerobic exercise 3) psychosocial problems

Final (lectures 1-18) Flashcards

(66 cards)