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Internal Med EOR > Neuro 1 > Flashcards

Neuro 1 Flashcards

1
Q

what is bell palsy

A

idiopathic, unilateral CN VII/facial nerve palsy leading to hemifacial weakness and paralysis due to inflammation or compression

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2
Q

is bell palsy a LMN or UMN disorder

A

LMN

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3
Q

what is responsible for most cases of bell palsy

A

reactivation of the HSV type 1 DNA in the geniculate ganglion

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4
Q

risks for bell palsy

A

DM
pregnancy (esp 3rd trimester)
post URI
dental nerve block

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5
Q

sx bell palsy

A

prodrome - sudden onset of ipsilateral hyperacusis (ear pain) followed by weakness

unilateral facial weakness or paralysis (forehead included) - unable to lift affected eyebrow and inability to fully close eyelid

weakness and paralysis only affects face

taste disturbance involving the anterior 2/3 of the tongue

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6
Q

what is the bell phenomenon in bell palsy

A

eye on the affected side moves laterally and superiorly when eye closure is attempted

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7
Q

dx bell palsy

A

dx of exclusion

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8
Q

tx bell palsy

A

no tx - supportive, artificial tears

prednisone esp if started within first 72 hours of sx onset reduced time to full recovery and increases likelihood of full recuperation

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9
Q

what is the MC overall cause of primary headache

A

tension headache

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10
Q

sx tension headache

A

bilateral, pressing, tightening bandlike, viselike, tight-cap, non throbbing (nonpulsatile) steady or aching, occipitonuchal or bifrontal headache, usually mild to moderate in intensity

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11
Q

exacerbating/relieving factors tension headache

A

exacerbating - worsened w stress, fatigue, noise, glare

not worse with routine activity

not associated w N/V, photophobia, or photophobia or focal neurological sx

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12
Q

PE tension HA

A

usually normal but may have increased pericardial muscle tenderness (head, neck, shoulders)

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13
Q

dx tension HA

A

clinical - diagnosis of exclusion (no specific tests)

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14
Q

tx tension HA

A

simple analgesics - NSAIDs mainstay of tx

Chronic management - TCAs (amitriptyline)

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15
Q

who is most likely to experience a migraine, men or women

A

75% of all persons who experience migraines are WOMEN

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16
Q

2 types of migraine

A

migraine without aura - MC

migraine with aura - classic but not common

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17
Q

sx migraine

A

HA - usually episodic lateralized (unilateral), throbbing (pulsatile) HA localized to the frontotemporal and ocular area; lasts 4-72 hours

associated w N/V, photophobia, phonophobia

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18
Q

exacerbating factors migraine

A

worsened with routine physical activity
stress
lack or excessive sleep
alcohol
chocolate
red wine
hormonal (oral contraception/menstruatioN)
dehydration

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19
Q

how long do auras typically last for migraine

A

focal neuro sx last < 60 min

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20
Q

most common aura for migriane

A

visual

21
Q

PE migraine

A

usually normal

may have aphasia, dysarthria, paresthesias, weakness

22
Q

dx migraine

A

clinical - at least 2
unilateral pain
throbbing (pulsatile) pain
aggravated by movement
moderate to severe intensity

at least 1
N/V
photophobia
phonophobia

23
Q

abortive/sx tx for migraine

A

mild to moderate - simple analgesics (NSAIDs)

moderate to severe - 5-hydroxytryptamine-1 receptor agonists - triptans or ergotamines - either alone or in combo w dopamine receptor antagonists (metoclopramide, prochlorperazine); CGRP antagonists (gepants); 5-HT 1F receptor agonists (Lasmiditan)

24
Q

prophylactic tx migraines

A

anti-hypertensives - BB or CCB, candesartan, NSAIDs, rimegepant

Anticonvulsants - Topiramate, Valproate

TCAs - amitriptyline

Botox

25
Q

what is cluster headache characterized by

A

hypothalamic activation with secondary activation of the trigeminal-autonomic reflex, probably via a trigeminal-hypothalamic pathways

26
Q

risks for cluster HA

A

male
age > 30
consumption of alcohol
tobacco

27
Q

triggers cluster HA

A

worse at night
alcohol
stress
hot weather
TV

28
Q

sx cluster HA

A

severe, unilateral, periorbital, deep (retroorbital), or temporal pain that is sharp, lancinating, and excruciating. HA last < 2 hours with spontaneous remission

occurs several times per day

29
Q

PE cluster HA

A

ipsilateral autonomic sx:
partial Horner’s syndrome - ptosis and/or miosis
nasal congestion or rhinorrhea
conjunctival injection or lacrimation
eyelid edema
forehead/facial swelling

occurs only during pain attack

30
Q

dx cluster HA

A

clinical
neuroimaging is suggested to exclude a cranial lesion (MRI or CT)

31
Q

tx cluster HA

A

100% oxygen first line - 6-12 L for 15-20 min

anti-migraines help during attack - sumatriptan preferred

32
Q

prophylaxis cluster HA

A

verapamil first line

33
Q

causes of meningitis and their associations

A

streptococcus pneumoniae - most common cause in adults

neisseria meningitides - most common in older kids; may be associated w petechial (purpuric) rash

group B strep - most common in neonates < 1 month

listeria monocytogenes - neonates, > 50, immunocompromised

34
Q

sx meningitis

A

HA
neck stiffness
photosensitivity
fever
N/V

may develop AMS or seizures

35
Q

PE meningitis

A

meningeal signs:
nuchal rigidity
positive brudzinski - neck flexion produces knee and/or hip flexion
positive kernig sign - inability to extend the knee/leg with hip flexion)

36
Q

dx meningitis

A

LP + CSF exam - decreased glucose < 45, increased neutrophils, increased protein, increased pressure

Head CT scan - best initial prior to LP if you need to rule out mass effect if any of these findings are present - papilledema, seizures, confusion, focal neurologic findings, > 60, immunopromised, hx of CNS dz

37
Q

tx meningitis

A

abx along with dexamethasone ASAP after LP or prior to head CT

dexamethasone reduces mortality

> 1 month - 50: vancomycin + ceftriaxone

> 50: vancomycin + ceftriaxone + ampicillin

neonates up to one month - ampicillin + either gentamicin and/or cefotaxime

head trauma or post-euro procedure - vancomycin + either ceftazidime or cefepime

38
Q

additional precautions for meningitis

A

droplet precautions for 24 hours after initiation of abx

post-exposure prophylaxis - ciprofloxacin or rifampin for close contacts w prolonged exposure > 8 hours or direct exposure to respiratory secretions

39
Q

MC cause aseptic meningitis

A

enteroviruses (coxsackievirus and echovirus)

40
Q

dx aseptic meningitis

A

dx of exclusion after ruling out bacterial meningitis

LP - normal glucose, lymphocyte predominance, protein count usually < 200

41
Q

tx aseptic meningitis

A

supportive

42
Q

what is encephalitis

A

infection of the brain parenchyma

43
Q

what is the MC identified virus in encephalitis

A

Herpes simplex virus 1

44
Q

sx encephalitis

A

HA
neck stiffness
photosensitivity
fever
N/V

focal deficitis - the presence of AMS, changes in personality speech, and movement distinguishes from aseptic meningitis

45
Q

PE encephalitis

A

focal neurologic deficits - hemiparesis, sensory deficits, cranial nerve palsies

46
Q

dx encephalitis

A

CT scan of head must be performed first to rule out space-occupying lesions

LP - normal glucose, increased lymphocytes

MRI - temporal lobe involvement characteristic of HSV

PCR testing of CSF fluid is the most accurate test for herpes encephalitis

47
Q

tx encephalitis

A

IV acyclovir - ASAP if encephalitis with no obvious cause

48
Q
A

Internal Med EOR (17 decks)

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