MTB 3 Flashcards
(78 cards)
1
Q
What percentage of carotid stenosis do we operate on? Don’t we operate on?
A
Greater than 70%
We don’t operate on 50%
2
Q
Risk factors that must be controlled in carotid stenosis?
A
DM HbA1C must be < 7%
HTN
LDL < 100
Stop tobacco smoking
3
Q
Dx for HA upon bending over to tie laces (Positional)?
A
Colloid cyst of 3rd ventricle
4
Q
Migraine HA Presentation
A
Visual disturbance Photophobia Aura Related to menses, emotions, food N/V
5
Q
Cluster HA Presentation
A
Frequent
Short duration
High intensity
Men more than Women
6
Q
What is tx for Cluster HA?
A
100% Oxygen
Ergots
Sumatriptan
7
Q
What is pseudotumor cerebri ass’d with?
A
Chronic lung dz
Addisons
Tetracycline
8
Q
HA ass’d with Vit A toxicity?
A
Pseudotumor cerebri
9
Q
HA w papilledema and diplopia? Why diplopia?
A
Pseudotumor cerebri
CN 6
10
Q
HA presents with tearing, red eye w rhinnorhea?
A
Cluster HA
- current, in “clusters” over time
11
Q
HA ass’d with Horner syndrome? Ipsi or Contra?
A
Cluster HA
Ipsilateral
12
Q
What must be assessed for with HA and red eye?
A
Glaucoma
13
Q
Retroorbital HA that starts suddenly, peaks rapidly, lasts about 2 hours?
A
Cluster HA
14
Q
HA with scalp tenderness, ass’d with polymyalgia rheumatica?
A
Temporal Arteritis
15
Q
Pt with 1st time convulsion + > 35 yoa, what must we rule out?
A
Brain tumor
16
Q
HA that is Bilateral?
A
Tension HA
17
Q
HA in young men, ass’d with alcohol?
A
Cluster
18
Q
Are Cluster HA’s uni or bilateral?
A
Unilateral
19
Q
Tx for Migraine HA?
A
Triptans
Ergotamine
20
Q
Testing for Pseudotumor cerebri?
A
CT or MRI to R/O intracranial mass lesion
LP: Increased Pressure (otherwise Normal)
21
Q
Most accurate test for Giant cell arteritis?
A
Bx
22
Q
Migraine PPX tx?
A
TCAs (Amitriptyline) Beta blockers CCBs - Verapamil SSRIs Botulinum Valproic Acid Topiramate
23
Q
Tx for tension HA?
A
NSAIDs
24
Q
Tx for Pseudotumor cerebri?
A
Weight loss
Acetazolamide
25
Pseudotumor cerebri Tx if medical does not work?
Ventriculoperitoneal shunt
26
Effective tx in cluster HA but not migraines?
100% Oxygen
Prednisone
Lithium
27
PPX for Cluster HA?
CCBs
| Preventive tx not necessary
28
Trigeminal Neuralgia Tx?
```
CN V
Carbamezapine
Phenytoin
Baclofen
Gabapentin
Lamotrigine
```
29
Who gets a Zoster vaccine?
All persons > 60 yoa to prevent shingles
30
Electrolyte disturbances that cause seizures?
```
Hypo or Hypernatremia
Hypoglycemia
Hypocalcemia
Hypomagnesemia
Hypoxia
```
31
Causes of seizures
```
VITAMINS
Vascular
Infxn
Traum
AI
Metabolic
Idiopathic
Neoplasm
pSychiatric
```
32
Definition of status epilepticus
Recurrent or continuous seizure that lasts 5-30 minutes
33
Best initial tx of status epilepticus
| Mangement if ineffective
Benzo - Lorazepam or diazepam IV
If persists -> Phenytoin or Fosphenytoin
Still persists -> Phenobarb
Still -> NM Blocking agent: Succinylcholine, Vecuronium, Pancuronium to allow for intubation
General anesthesia - Midazolam or Propofol
34
Which has fewer AE's: Phenytoin or Fosphenytoin?
Fosphenytoin
35
Long term AE's for Phenytoin?
```
IV - HyptoTN, AV block
Vertigo
Ataxia
Gingival Hyperplasia
Hirsutism
Rash
LA
```
36
What is a partial seizure?
Focal to one part of body
| I.e. Just leg or just arm
37
What is a simple v complex seizure?
Simple - in tact consciousness
| Complex - LOC
38
Describe a tonic clonic seizure
Grand mal
Generalized
Varying phases of muscular rigidity (tonic) then jerking of muscles (clonic)
39
What is the first line tx for a Partial seizure?
Carbamazepine
| Phenytoin
40
What is a partial w secondary generalization?
Tonic clonic manifestation - diffuse muscle aches
Increased CPK
Tongue biting
Loss of bladder control
41
What is a complex seizure?
| Presentation?
LOC w automatisms
| Chewing, picking hand movements, lip smacking
42
Absence (Petit mal) seizure EEG pattern?
Generalized, symmetric 3-Hz spike and wave discharge pattern
43
What is Lennox-Gustant syndrome
Pediatric seizure syndrome
Less than 7 yoa
Mental Retardation
44
Do we start antiepileptic drugs for a single seizure?
No. Unless:
it is status epilepticus
Fam Hx
Abnormal EEG
45
When do we discontinue seizure meds? How do we test for this?
When pt has been seizure free for 2 years
| Test with sleep deprivation EEG
46
Intracranial HTN = ICH
Pressure
Causes
IC pressure > 20 mmHg
| Trauma, lesion, hydrocephalus, impaired CSF outflow
47
Sx's seen in ICH
Sx's: Diffuse HA, worse in morning, N/V early in day, visual changes, papillaedema, confusion, somnolence, Cushing reflex (HTN + bradycardia)
48
Cerebral Salt wasting syndrome
| Pathophys
Inappropriate secretion of vasopressin, causes H2O retention
- Increased secretion of ANP/BNP causing cerebral salt wasting -> HYPOnatremia
- resolves in 1-2 wks
49
What is commonly ass'd with ICH?
SIADH
50
How is presentation of SAH different from meningitis?
SAH
- very sudden in onset
- LOC
51
Best initial test for SAH
CT w/out contrast
52
Most accurate test for SAH
```
LP Puncture - if FN CT
CSF:
- Xanthochromia - 4-6 hrs to develop
- Increased WBCs
- Ratio of WBCs/RBCs is normal
```
53
What should one suspect if WBC/RBC ratio is increased? (WBC count exceeds normal)
Meningitis
54
Normal ratio of WBC/RBC in CSF?
One WBC for every 500-1000 RBCs
| 1:500
55
"Boot shaped" hemorrhage?
SAH
56
EKG of SAH
Large or inverted T waves = cerebral T waves
| - excessive sympathetic activity
57
How do we find the site of aneurysm?
Angiography
58
When do we use contrast in CT/MRI of head?
Detection of mass or lesion - cancer or abscess
| NOT with blood
59
Tx for SAH
1. Nimodipine prevents ischemic stroke
2. Embolization (coiling)
3. Ventriculoperitoneal shunt if hydrocephalus develops
4. Seizure ppx - Phenytoin to prevent
60
Complication w Nimodipine
First 24 hours -> Rebleeding
| Days 3-10 -> Vasospasm
61
Embolization or surgical clipping for SAH?
Embolization
62
Pt presents with burning pain and paralysis in UE, relative sparing of LE?
Central cord syndrome
| - elderly pts secondary to forced hyperextension of their neck
63
Spinal cord problem ass'd with burst fracture?
Anterior cord syndrome
64
What is presentation of anterior cord syndrome?
Total loss of motor function below the level of the lesion w loss of pain and temp on both sides below lesion
65
Test for anterior cord syndrome?
MRI
66
Loss of all fnc except for posterior column, flaccid paralysis below level of lesion, loss of DTRs at level of lesion, loss of pain and temp?
Anterior Spinal Artery Infarction
67
What causes subacute combined degeneration of cord?
| Presentation
B12 Deficiency
Neurosyphilis
- Affect the posterior column - so position and vibration are lost
68
How does spinal trauma present?
Acute onset of limb weakness/sensory changes below level of injury
Sphincter fnc impaired
Loss of DTRs followed by hyperreflexia below level of trauma
Tx: glucocorticoids
69
Pt presents with motor and sensory deficit, change in bowel/bladder dysfunc, after after having an epidural catheter?
Epidural hematoma from a traumatic insertion
70
What is transverse myelitis?
Inflammation of the spinal cord causes axonal demyelination
71
How does transverse myelitis present?
Weakness, numbness of limbs
| Ass'd with CMV, spinal cord injury
72
Brown Sequard Syndrome
2 Ipsi, 1 Contra
Unilateral hemisection of SC from injury
Loss of pain/temp on Contra
Motor Fnc + position/vibration - Ipsi
73
Loss of pain/temp bilaterally upper back and both arms?
Syringomyelia
Capelike distribution
Will also have loss of reflexes and muscle atrophy
74
What is Syringomyelia ?
Fluid filled dilated central canal
| - Tumor or trauma
75
What is communicating Syringomyelia ass'd with?
Arnold Chiari
76
Nocturnal HA + morning vomiting?
Intracranial pathology
77
Most accurate test for Syringomyelia?
MRI
78
Tx for Syringomyelia?
Surgical removal of tumor
