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#DOOS Neuro > Lect 9 & 10 > Flashcards

Lect 9 & 10 Flashcards

1
Q

what is multiple sclerosis

A

chronic inflamm dz of CNS

may not involve specific antibodies

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2
Q

what’s the pathology of MS?

A

inflammation disrupts the BBB, T-Cells, and macrophages enter brain tissue immead around the blood vessel involved and cause damage

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3
Q

Is MS a “white matter dz”?

A

sclerosis of myelin in white matter is the most easily visualized one MRI, HOWEVER damage of MS is not limited to white matter

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4
Q

Imaging for MS?

A

MRI WITH contrast to spot inflamm lesions (most freq occur near ventricles)

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5
Q

what may be seen on LP of MS pt?

A

75-80% of pts have oligoclonal bands of non-specific IgG

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6
Q

8 most reported sx of MS

A

numbness, tingling, fatigue, pain, musc spasms, difficulty walking, HA, emotional changes

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7
Q

________ is the first sign of MS in 15-20% of ppl

A

optic neuritis (~1/2 of ppl with optic neuritis will eventually be dx with MS)

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8
Q

5 sx of optic neuritis (usually UL or BL?)

A 
usually unilateral:
pain with eye movement or a dull ache behind eye
vision loss or temp reduction in vision
loos/dulling of color vision
reduced peripheral vision
flashing lights with eye movement
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9
Q

necessary Hx and imaging to dx MS

A

2+ attacks (clincally or MRI documentation) attacks must be disseminated in TIME and SPACE
OR
One year of progressive sx and MRI showing lesions disseminated in space

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10
Q

what is clinically isolated syndrome (CIS)?

A

dx for pts who had only one (monofocal) attack, or 2+ (multifocal) attacks simultaneously.
- may progress to MS and should be treated the same as MS

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11
Q

2 tx for acute MS attack

A

high dose IV corticosteroids (provide relief but doesn’t affect course fo the dz)

plasmapheresis for those who dont respond to corticosteroids

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12
Q

what 3 disease modifying first-line drugs for MS tx prevent relapsing?

A

Interferon Beta- 1a
Interferon Beta- 1b
glatiramer acetate

(all 3 are basically equvalent)

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13
Q

disease modifying drugs for MS are only effective for __________

A

relapsing-remitting type to prevent relapses by 1/3rd

–there is no tx for progressive MS

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14
Q

MS is predominant in _____(m/f) between ___-____(age)

A

females

20-50

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15
Q

what is a coma

A

prolonged, deep state of unconsciousness (unable to move or respond to stimuli)
MUST BE GREATER THAN 6 HOURS

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16
Q

coma is caused by dysfxn of _______ or ________

A

cortex or reticular activating syst

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17
Q

what are the 3 components of glasgow coma scale? Is 3 or 15 the most severe coma?

A

eye opening
verbal
motor
15 is normal, and 3 would be the worst coma with no eye opening, no sounds, and no movement

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18
Q

__ is the minimum score on glasgow coma scale

A

3

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19
Q

Name 4 coma etiologies

A

drug intoxication, OD, or misuse
hypoxia
stroke
trauma

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20
Q

Name 6 dx tests for coma

A 
toxin screen
glucose
BMP
brain imaging
EEG
other neurological tests
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21
Q

If pt presents like coma, what must you r/o?

A 
locked in syndrome (they have preserved vertical eye movement)
psychogenic unresponsiveness (caloric stimulation: pour water in their ear)
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22
Q

decorticate vs decerebrate

A

decorticate - cortex damage, flexor posturing (hands on chest)

decerebrate - brain damage, extensor posturing (arms at side)

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23
Q

tx for coma is

A

mostly supportive (breathing support, rehab)

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24
Q

what is a concussion

A

a TBI that affect the brain’s function (***NOT necessarily structural damage present)

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25
Q

some concussions cause a loss of consciousness but most cause…

A

a feeling of being stunned dazed or confused

26
Q

a brief period of retrograde and anterograde _____ is common with a concussion

A

amnesia

27
Q

severe concussion may precipitate ________ or ______

A

convulsions or “autonomic signs” (pallor, hypotension, bradycardia, lightheadedness)

28
Q

most ppl fully recover from concussion but some develop _____________

A

post concussion syndrome (persistent concussion sx that last up to a yr)
(sx: difficulty thinking/remembering, n/v HA, irritability, sleeping more than usual, etc)

29
Q

what is the general management of post concussion syndrome

A

education on healthy lifestyle, and each sx is treated seperately (ex: migraine, nausea etc)
(hydration, nutrition, sleep hygiene, exercise, stress management)

30
Q

what are the 4 primary HA DOs

A

cluster & variants
migraine and variants
tension-type HA
medication overuse AH

31
Q

mnemonic for causes of 2dry HA

A

VINDICATE

32
Q

name 5 etilogies of 2dry HA

A 
lifestyle (dehydration, poor nutrition, sleep deprivation)
hypoxia
sinusitis
TMJ
hangover
33
Q

________ is the most common 1ry HA in ADULTS

A

tension-type

34
Q

describe tension type HA

A

usually BL, constant pressure in occipital/frontal regions usually precipitated by stress or hunger

35
Q

tension-type HAs usually do not have autonomic sx (N/V) or auras/visual sx, though ________ and _________ are sometimes present

A

photophobia and phonophobia

36
Q

muscles may be tender in tension type HA though contractions are not the cause, there for ___________ should not be prescribed

A

muscle relaxants

37
Q

what 2 tx are useful for acute tension-type HA

A

OTC pain meds (ibuprofen, acetaminophen)

triptans

38
Q

____________ are not indicated for ANY HA

A

opiates

39
Q

what is a cluster HA

A

repeated episodes of excruciatingly severe UL HA lasting 15mins-3hrs (possibly the most painful condition in medicine)

40
Q

Cluster HA can relapse and remit and happen at the same time very day, or they can happen without times of remission, this is called ______________

A

chronic cluster HA

41
Q

name 6 sx that may be associated with the pain of a cluster HA

A

ipsilateral ptosis, miosis, conjunctival injection, lacrimation, rhinorrhea

42
Q

cluster HAs can be worsened by smoking or ETOH, attacks can often _____________, which is NOT seen in migraines

A

wake the pt from sleep

43
Q

For cluster HA OTC pain meds ____(are/are not) effective. _______ and _________ are also useful treatments

A

OCT are NOT helpful
100% oxygen can be helpful if admin early
and triptans are usually helpful

44
Q

Cluster HA affects ____(f/m) 5:1, 20-50yo, with blue/hazel eyes

A

MEN 5:1

45
Q

what is a migraine

A

typically UL throbbing/pressure HA with sever pain and autonomic sx (N/V photophobia) lasting 1 hr to 3 days

46
Q

migraine is more common in ____(f/m)

A

females

47
Q

stages of migraine: Prodrome —> ________—-> pain/HA phase —->_____

A

aura

postdrome

48
Q

with a migraine the _____ phase may be absent, esp in young ppl

A

pain

49
Q

migraine with aura is called ____

migraine w/o aura is called _____

A

classic

common

50
Q

define chronic/converted migraine

A

you have more days with migraines than days w/o

51
Q

____, ______ and _____ supplements may be helpful in prevention of migraine

A

coenzyme Q
riboflavin (b2) in very high doses
magnesium

52
Q

name 4 preventative migraine medications

A

beta-blockers, Ca channel blockers, ACE inhibitors

53
Q

_____ not indicated for migraines

A

opiates

54
Q

what are common adverse rxns to amiodarone

A

tremor, ataxia, peripheral neuropathy

55
Q

statins cause _____, ____, and ____

A

myotonia, myopathy, and myalgias

56
Q

salicylates cause _____, _____, and _____ at high doses

A

seizures, confusion, restlessness

57
Q

NSAIDs can lead to ______ when taken for HA freq

A

medication overuse HA

58
Q

oral contraceptive/HRT inc risk for

A

stroke

59
Q

nicotine is a powerful ______; withdrawl makes you anxious, therefore taking nicotine makes you feel ______

A

stimulant

relaxed

60
Q

caffeine cause _________

A

enhanced physiologic tremor

61
Q

chronic alcoholism depletes ____ and _____

A

B1- thiamine
B3 -niacin
(polyneuropathy and optic neuropathy)

#DOOS Neuro (6 decks)

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