Hon Review of All the things

Question 1

what 3 symptoms classically make up meinere’s?

Answer 1

tinnitis, vertigo, hearing loss

Question 2

pts with meinere’s present with? complain of?

Answer 2

low frequency hearing loss, fullness in ears, vertigo that comes in spells

Question 3

vestibular problem with meinere’s?

Answer 3

horizontal + rotary nystagmus

Question 4

what is considered a peripheral cause of vertigo?

Answer 4

the labyrinth (PNS starts at spinal cord and goes out)

Question 5

what does Romberg’s test for?

Answer 5

proprioception, posterior columns (peripheral test for dorsal test of dorsal columns)

Question 6

What age group is diagnosed with Freidrich’s ataxia? COD?

Answer 6

young people; cardiomyopathy

Question 7

what does ataxia look like? how would a pt describe it?

Answer 7

disequilibrium, falling, poor balance, hyporeflexic, decreased m. strength

Question 8

if a pt has a herniation syndrome what may be one of their symptoms?

Answer 8

pupil dilate

Question 9

what kinds of things can be examined on a comatose pt?

Answer 9

pupillary light response, extra ocular movements, oculocephalic reflexes, corneal response, can try pain response: pinch nail bed, withdrawal to noxious stimuli, check breathing patterns

Question 10

where can a lesion occur that would cause coma?

Answer 10

both sides of brain involved, brainstem or both, (lesion of bilateral cortex, midbrain/pons/medulla)
not coma causes: hypothalamus, spinal cord, MS lesions, unilateral BG, unilateral thalamus

Question 11

what does it mean if there is an absent oculocephalic reflex when stimulated with cold on L and intact on R?

Answer 11

damage to gaze center in R pons

Question 12

pt comes into ER after being found down by family members. Pt is sleepy, drowsy, can’t follow commands, eyes deviate to L, babinski found on R, lg L MCA stroke.
Neuro change hours later:
unarousable, L eye down and out, extensor posture, bilateral babinski.
What happened?

Answer 12

Uncal herniation L to R

Question 13

what is common in the presentation of a pt with hepatic coma/encephalopathy?

Answer 13

both hemispheres affected, eyes adducted and down, asterictis (hyperextended at wrist, flicking)

Question 14

cold water into the R ear of a coma pt?

Answer 14

normal= conjugately gaze to the R

Question 15

migraines: more common in? characteristics?

Answer 15

in women, unilateral (or bilateral) throbbing/sharp/pressure, N/V, photophobia, phonophobia

Question 16

What classifies a chronic migraine?

Answer 16

15-16days/month, 4+ months, hx of migraine HA,

Question 17

what can be used to prevent migraine?

Answer 17

beta blockers
Ca channel blocker
AEDs: topiramate, valproic acid
TCAs: amytriptiline, noratriptilline
Botox** FDA approved

Question 18

which sex more frequently as cluster HA? proven association with? symptoms? prodrome?

Answer 18

men; proven association with sleep apnea; periorbital pain, sharp/boring/penetrating pain, 30-90 mins, same time of year, recurring; burring nose/inner canthus ipsilateral side

Question 19

description of trigeminal neuralgia?

Answer 19

unilateral, electric/sharp/shooting, 1+ division of trigeminal n., pain comes in paroxysms in seconds, few seconds and stops on/off thru day

Question 20

what typically brings on trigeminal neuralgia?

Answer 20

chewing, talking, hot/cold liquids/foods

Question 21

what meds are used to treat trigeminal neuralgia?

Answer 21

anticonvulsants: Carbamazepine***, oxcarbamazepine, gabapentin

Question 22

what is the triad for parkinsons?

Answer 22

tremor, bradykinesia, rigidity

Question 23

which symptom of PD first?

Answer 23

tremor, unilateral to start

Question 24

what are the other parkinsonisms called?

Answer 24

akinetic rigid syndromes

Question 25

what are the symptoms of Progressive Supranuclear Palsy?

Answer 25

bradykinesia, rigidity, eyes vertical gaze fail, volitional gaze impaired

Question 26

clinical features of diffuse lewy body dz?

Answer 26

psychotic symptoms, visual (small animals/kids)= early feature, autonomic dysfunction, OFTEN FALLING, slow/stiff, festinating gait, MMSE may be normal (not much memory loss)

Question 27

Ad symptoms?

Answer 27

early: memory loss, (missed appts, forget where objects are, can't balance checkbook) late: kids stealing from them, spouse cheating; mood= intermittent agitation

Question 28

what may imaging reveal for AD?

Answer 28

may see generalized atrophy or may be normal for age (blood work will be normal)

Question 29

What should you expect if a pt has intermittent episodes of encephalopathy, unexplained delirium, episodes lasting days?

Answer 29

lewy body

Question 30

what would give away vascular dementia?

Answer 30

focality

Question 31

what is the triad associated with normal pressure hydrocephalus? which improves with shunt?

Answer 31

dementia, gait disturbances, urinary abnormalities; gait improves with shunt

Question 32

which kind of migraine has aura? why more common in women?

Answer 32

classic; hormones

Question 33

what are the worrisome symptoms to make us suspect a secondary HA?

Answer 33

"worst HA of life," atypical HA for pt, fever, focal symptom, late onset (>50-55), very rapid onset (secs to mins max intensity)

Question 34

if a pt with a sudden severe HA collapses to ground unconscious and awakes in the ER with some weakness/lethargy what is our diagnosis until proven otherwise?

Answer 34

subarachnoid hemorrhage | order bloom work, CT (5-10% not seen on), LP can be done

Question 35

description of wilson's dz?

Answer 35

young person, liver and brain affected, copper metabolism deficiency, brady and hyperkinetic disorder

Question 36

will one test show MS? what are some test results that may further lead you to suspect MS?

Answer 36

no; increased IgG synthesis with oligoclonal bands in CSF

Question 37

what kind of dz is MS?

Answer 37

dz of young people 20-30s, exacerbations and remissions, dz of CNS: spinal cord and brain

Question 38

what dz will have decrease arm swing?

Answer 38

PD

Question 39

what are the dz modifying agents in MS?

Answer 39

IFNs, monoclonal antibodies, glaterimur acetate, -timizuab, dimethyl fumurate

Question 40

what do steroids do in MS?

Answer 40

decrease the amount of time in exacerbation

Question 41

How is MS diagnosed?

Answer 41

by multiple lesion over space and time

Question 42

if a pt presents with optic neuritis and mono phasic lesions what should you think?

Answer 42

ADEM (acute disseminated encephalomyelitis); follow these pts closely as this may become MS (MRI 3-6 months)

Question 43

What is the most common reason that someone with controlled epilepsy may have a seizure?

Answer 43

missed a medication

Question 44

how many epileptic pts are controlled on first medication?

Answer 44

2/3

Question 45

what is the most important thing in determining if a seizure or something else actually occurred?

Answer 45

hx with witnesses to event

Question 46

which meds can treat both primary generalized or partial seizures?

Answer 46

valproic acid, lamotrigine, zonisamide, levotracetam

Question 47

what are some things that can be confused with stroke?

Answer 47

hyper/hypoglycemia, hepatic abnormalities, MIGRAINES*

Question 48

what meds help treat stroke?

Answer 48

aspirin, clopidigril, avernox

Question 49

what does a CT of stroke pt look like at 3 hours? 2 days?

Answer 49

normal; hypodensity

Question 50

what is the first approach to a pt?

Answer 50

ABCs

Question 51

what are cases to tx with warfarin?

Answer 51

intermittent A fib, prosthetic valve, MI (EF 10-15%)

Question 52

what are the features of ataxia telangectasia?

Answer 52

ataxia telangectasia- spider veins and sinopulmonary problems

Question 53

pt comes in following first grand mal seizure. Had head/eye turn (automatism). Pt has had funny feeling in past but no seizure before. What does this tell us?

Answer 53

pt likely had partial seizures without generalization; pt had epilepsy