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AANP Study Cards > Nervous System > Flashcards

Nervous System Flashcards

1
Q

What are red flags for headache

A
  • thunder headache
  • worst headache of my life
  • first headache at 50 years or older
  • sudden change in LOC
  • focal neurological signs (unequal pupil size, hemiparesis, loss of function, poor gag reflex, difficulty swallowing, aphasia, sudden loss of vision, visual field defect)
  • Headache with papilledema
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2
Q

Sudden and rapid onset of severe headache described as the worst headache of my life, nausea and vomiting, neck pain or stiffness. Photophobia, and visual changes with rapid decline in LOC

A

-Subarachnoid hemorrhage

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3
Q

Acute onset of high fever, severe headache, stiff neck (nuchal rigidity), meningismus with alerted mental status. Classical purple petechial rash

A

Meningitis

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4
Q

Acute onset of headache that is located over 1 temple of an older patient. May experience burning pain over temporal artery. Indurated, cord-like temporal artery.
-Visual issues, blindness in affected eye (amaurosis fugax), elevated ESR/CRP

A

Temporal arteritis

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5
Q

Acute onset of stuttering/speech disturbances, one-sided facial/arms/leg weakness (hemiparesis)

A

Stroke

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6
Q

Episodic visual loss or diplopia, problems with balance and walking, numbness, paresthesias on one side of the face. Accompanied by urinary incontinence, bowel dysfunction. Lhermittes sign (bending forward/flexion creates an electric shock)

A

-MS

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7
Q

The trigeminal nerve has 3 branches

A
  • Ophthalmic (V1)
  • Cheek (V2)
  • Jaw (V3)
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8
Q

Biceps reflex responds to what spinal cord segment

A

C5, C6

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9
Q

Triceps reflex responds to what spinal cord segment

A

C7, C8

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10
Q

Patellar reflex responds to what spinal cord segment

A

L3, L4

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11
Q

Achilles reflex responds to what spinal cord segment

A

S1, S2

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12
Q

CN IX (9) innervates

A

the movements of the soft palate

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13
Q

CN XII (12) innervates the

A

tongue

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14
Q

What is Kernig’s Sign

A
  • Flex patients hips one at a time then attempt to straighten the leg while keeping the hip flexed at 90 degrees
  • If resistance to leg straightening this is +
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15
Q

What is Brudzinski’s

A

Passively flex/bend the patients neck towards the chest

+ if patient reflexively flexes the hips and knees to relieve pressure and pain

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16
Q

Rash at tip of nose and temple area you must

A

rule out shingles of the trigeminal nerve

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17
Q

Mild TBI is defined as a GVS score ___ to ___

A

13-15

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18
Q

Sx of TBI include

A
  • confusion
  • headache
  • dizziness
  • vertigo
  • poor balance
  • nausea
  • comiting
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19
Q

Indications for hospital admission after TBI

A
  • glasgow coma scale <15
  • Seizure or other neuro defects
  • Recurrent vomiting
  • Abnormal head CT
20
Q

What is the classic presentation of MS

A
  • episodes of visual loss
  • diplopia
  • nystagmus
  • vertigo
  • problems with balance and walking
  • foot drop
  • numbness and paresthesia
  • bowel or urinary incontinence
  • Lhermittes sign
21
Q

What is lhermittes sign

A

Bending neck forward in flexion produces an electric shock like sensation that runs down the back of the neck

22
Q

What is the treatment of acute bacterial meningitis

A

-3rd generation cephalosporin IV plus chloramphenicol IV

23
Q

What is the prophylaxis of close contacts with meningitis

A

-rifampin PO or Ceftriaxone IM

24
Q

Scotomas are

A

blind spots in the visual field

25
Q

Throbbing unilateral pain, photophobia, phonophobia and nausea/vomiting

A

Migrane

26
Q

Intense, brief, sharp stabbing pain, one cheek

Can be aggravated by cold,walking, touch, chewing

A

Trigeminal neuralgia

27
Q

Severe ice pick piercing pain behind one eye and temple with tearing, rhinorrhea, ptosis and miosis (horner syndrome)

A

Cluster headache

28
Q

How is temporal arteritis treated

A

High dose prednisone for severe weeks

29
Q

Bilateral joint stiffness and aching located in the posterior neck, shoulders, upper arms, hips (pelvic girdle)

A

PMR

30
Q

What is first line treatment of Trigeminal neuralgia (Tic Douloureux)

A

High dose anticonvulsants like carbamazepine or tegretol

31
Q

With trigeminal neuralgia what imaging is indicated and why

A

-MRI or CT to rule out tumor or artery pressing on nerve

32
Q

Bells palsy is associated with cranial nerve

A

VII

33
Q

What is the treatment plan for bells palsy

A

High dose glucocorticoids x7 days and wean + valacyclovir or acyclovir

34
Q

To limit rebound headaches then limit NSAID use to ____ days

A

<15 days

35
Q

ABCD2 score for stroke risk after TIA

A 
Age >65 (1)
BP >140/90 (1)
Clinical features of TIA
-unilateral weakness +/- speech impairment (2)
-Speech impairment without weakness (1)
Duration of TIA
->60 minutes (2)
-10-59 mins (1)
Diabetes
36
Q

What are risk factors for stroke

A
  • a.fib
  • hypertension
  • aneurysm
  • trauma
  • bleeding abnormalities
  • use of anticoagulants
  • use of stimulants
  • sickle cell disease
  • DM
  • OCP use
  • smoking
  • thrombophilia
37
Q

What are side effects of triptans

A
  • nausea
  • dizziness
  • vertigo
  • drowsiness
  • discomfort of throat/nose/tomgie
38
Q

What are side effects of NSAIDs

A
  • GI pain/bleeding/ulceration
  • renal damage
  • increased BP
39
Q

Management of Acute Migraine

A
  • ice pack on forehead
  • rest in quiet room
  • triptan
  • Torodal
  • Prochlorperazine for nausea
40
Q

Prophylaxis for Migraine

A
  • Amitriptyline
  • Beta Blocker
  • Venlafaxine
  • Topiramate
41
Q

Management of Cluster Headaches

A
  • 100% O2 at 12L/min via mask

- Intranasal 4% lidocaine

42
Q

What are side effects of tricyclic antidepressants

A

sedation, dry mouth, confusion

43
Q

What are contraindications of beta-blockers

A
  • 2nd or 3rd degree AV block
  • Asthma
  • COPD
  • Bradycardia
44
Q

Butterbar is an alternative remedy for

A

Headache

45
Q

Migraines can last

A

3 to 72 hours

AANP Study Cards (20 decks)

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