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Clinical Medicine Final > Neuro > Flashcards

Flashcards in Neuro Deck (357):
1

What can unilateral HA be

Migraine, trigeminal neuralgia

2

What can temporal HA be

Temporal arteritis

3

What can occipital HA be

Tension HA

4

What can HA with eye association be

Acute glaucoma, temporal arteritis, sinusitis, migraine

5

What is the difference between HA with gradual vs sudden onset

Gradual = usually benign
Sudden = may be more serious

6

HA characterized as pounding/pulsatile =

Migraine

7

HA characterized as sharp/stabbing =

Trigeminal neuralgia or cluster HA

8

HA characterized as pressure/squeezing =

Tension HA

9

HA associated with anxiety =

Tension HA

10

HA associated with auras =

Migraine

11

HA associated with vision change =

Temporal arteritis or gluacoma

12

HA associated with n/v =

Increased ICP or Migraine

13

HA associated with lacrimation/rhinorrhea =

Cluster HA

14

HA associated with photophobia/phonophobia =

Migraine or Meningitis

15

Migraines affect men or women more?

Women

16

At what age do migraines usually start? Disappear?

Onset = 10-14 y/o
Disappear in the 50's

17

Depolarization theory of migraines =

Depressed activity areas lead to platelet and mast cell activation

18

Seratonin release may cause migraines how?

Fluctuations in catecholamine levels cause alternating vasoconstriction/vasodilation which causes wall stretching & pain

19

What are the types of migraines (the most often seen)

Common (w/o aura) or classic (with aura)

20

What are the indications for imagining in pt presenting with a migraine?

1st/worst migraine
New onset w/ age > 50y/o
Sudden onset HA ("thunderclap")
Abnormal neuro exam
Rapid onset with strenuous activity
HA awakens from sleep
Meningea signs (n/v, altered mental status, personality changes)

21

What is the 1st line Tx of acute migraine?

Excedrin migraine or NSAIDs

22

What is 2nd line Tx for acute migraine?

Triptans or Dihydroergotamine (DHE-45)

23

What is the best Tx of migraine (not acute)

Triptans = Sumatriptan (Imitrex) or Treximet (sumatriptan + naproxen)

24

What are RFs for migraines

Family hx, obesity, sleep apnea, head injury, female,, analgesic overuse, & caffeine

25

What may cause a rebound HA

Overuse of medication for migraine (> 10 days of the month) especially Narcotics!

26

What is the Tx of rebound HA

Go cold turkey from the meds that are causing it, try triptan or steroids

27

When should you start migraine prophylaxis

> 2 HAs/week
Severe HA
Prolonged duration > 2 days

28

What is the best migraine prophylaxis med?
What else is an option?

Best = Propranolol LA (beta blocker)
Other = tricyclic antidepressants or antiseizure drugs (not in preggos though!)

29

What is a major side effect of the antiseizure drugs?

Unwanted weight gain

30

What are common features of a Common Migraine

Pulsatile throbbing (50%)
Unilateral HA (50%)
Lasts hrs - days
Associated with n/v
Photophobia/phonophobia

31

What are common features of a Classic Migraine

Aura (20%)
Scintillating scotomas
Fortification spectrum

32

What is the prodrome phase

Increased excitability/irritability, fatigue, depression, appetite changes/cravings

33

Aura that occurs without a HA is called...

Acephalgic migraine

34

Sensory aura =

Numbness, paresthesia, dysphasia

35

What artery do basilar migraines effect?
What are the SxS?

Artery = basilar artery
SxS = HA, vertigo, slurred speech, impaired coordination (younger pts) NO MOTOR DEFECTS

36

SxS of hemiplegic migraine =

Paralysis on one side of body, may persist x 24hrs w/ or w/o HA

37

SxS of ophthalmoplegic migraine =

HA, eye pain, vomitting, ptosis

38

Catemenial migraines occur with...

Menses
Usually disappear with menopause & pregnancy
Occurs 2-3x a day during menses

39

If a migraine is VERY refractory what might you try to use?

Lidocaine, caffeine protocols, or propofol infusions

40

What sex is cluster HA more common in

Men (4X more)

41

What is the main RF for cluster HA

Tobacco use - MUST QUIT

42

What are possible causes of cluster HA

Vascular dilation
Trigeminal nerve stimulation
Circadian rhythms

43

Pts with cluster HA will often complain they are triggered by...

Alcohol ingestion

44

Cluster HA SxS/description =

Excruciating stabbing pain (suicide HA)
Unilateral behind the eye, jaw, or teeth
Last 15min - 3hrs

45

What are the requirements to Dx cluster HA

Must have one of the following:
- Lacrimation, ipsilateral flushing/sweating, ipsilateral nasal DC, conjunctival redness, horner's syndrome (ipsilaterl ptosis or miosis)

46

What is the Tx of cluster HA

Triptans
OXYGEN (20min) = complete relief in 78% of pts
Prophylaxis = break the cycle

47

What are the SxS of tension HA

Vice-like, gripping HA that forms a band across the forehead bilat
Radiates into posterior neck/trapezius
NO n/v, photo/phonophobia & not worse with activity

48

What is the Tx of tension HA

Non-pharm = exercise, relaxation therapy/counseling, yoga, PT, acupuncture
Pharm = NSAIDs, Tylenol, myofascial trigger point injections, TCAs or SSRI

49

What is the origin of tension HA

It has a myofascial origin

50

RFs for tension HA

Stress/anxiety, depression, overwork, lack of sleep, posture, conversion syndrome

51

When does post-traumatic HA occur (be specific not a smart ass)

Within the first 7 days of the injury
Acute: < 2mo after injury; Chronic: >2mo after

52

What type of HA is it characterized as

Mix of migraine and tension HA

53

What do pts with post-traumatic HA often develop

Rebound HAs

54

How do you Tx post-traumatic HA

Hard to treat; treat as the HA it presents as and if that doesn't work adjust Tx

55

What is idiopathic intracranial HTN (IIH) also called

Psuedotumor cerebri or benign intracranial HTN (BIH)

56

Who is most likely to have IIH

Women 15-44 y/o that are obese

57

What are the SxS of IIH

Retro-orbital pain (worse with movement)
Throbbing (worse in morning)
N/V
Monocular/binocular vision loss
Pulsatile tinnitus (60% of pts)

58

What is the MC PE finding with IIH

Papilledema

59

What are the diagnostics for IIH

LP opening pressure > 200
MRI neg for masses/hydrocephalus

60

What is the Tx of IIH

Lifestyle changes
Diuretics
NSAIDs/TCAs for HA management
Large volume LP
Sx in extreme cases

61

Prevelance of trigeminal neuralgia...sex & age =

Sex = women
Age = >40y/o with peak of 60-70 y/o

62

What is the biggest risk for trigeminal neuralgia

Multiple Sclerosis (MS)

63

Which side is more commonly affected in trigeminal neuralgia

Right side

64

How is trigeminal neuralgia described

Stabbing, lancinating, electric shock pain that lasts about 2min and occurs multiple times a day or month but becomes more frequent over time

65

What causes trigeminal neuralgia

Demyelination of trigeminal nerve that causes pain even with light touch

66

What branches of the trigeminal nerve are MC affected in trigeminal neuralgia

Maxillary and mandibular

67

Temporal arteritis AKA...

Giant cell arteritis

68

What is GCA commonly associate with

Polymyalgia rheumatic (50%)

69

What are the SxS of temporal arteritis

Temporal HA
Jaw claudication
+/- diplopia, visual field cuts, and systemic manifestations

70

What will PE reveal for temporal arteritis

Tenderness over temporal arteries
Diminished pulses

71

How is temporal arteritis Dx

Temporal artery biopsy (pos 2 days after starting Tx)

72

What is the immediate Tx of temporal arteritis

Corticosteroids while biopsy results are being processed

73

What are the causes of a traumatic brain injury (TBI)

Penetrating injury or closed head injury

74

What is primary damage in TBI

Skull fx, contusion/bruising, hematomas/blood clots, lacerations, nerve damage (diffuse axonal injury)

75

What is secondary damage in TBI

Edema & infection

76

What are the main causes of concussion

Deceleration injury or coup-countercoup injury

77

Who is most likely to suffer a concussion

Athletes especially in contact sports

78

What are the main SxS of a concussion

Disorientation
Amnesia
Confusion (vacant stare, delayed answers, poor concentration)

79

What % of concussions result in LOC

10% will have LOC

80

What are the MOST COMMON SxS of concussion

HA, dizziness, & impaired executive function

81

What are the diagnostic tests for consussion

CT or MRI (although minor will appear normal)

82

What is a Grade 1 concussion

"Ding" concussion, confusion, no LOC, SxS last for < 15min

83

What is a Grade 2 concussion

No LOC, SxS last > 15min

84

What is a Grade 3 concussion

LOC

85

What is the gold standard for determining severity of a concussion

Gasglow Coma Scale

86

What constitutes as minor, moderate, and severe on the gasglow scale

Minor: 13-15
Moderate: 9-12
Severe: < 8

87

What is the best Tx of concussion

Rest

88

Who needs a CT with concussion

There is a long list. Main one to know is seizure, neruo deficits, and anticoagulation ABSOLUTELY requires CT

89

What is the problem with multiple concussion

It will take longer to heal each time, will result in more easily being concussed again, may lead to more severe issues (like post-concussion syndrome)

90

The typical course for an athlete to be cleared to resume play takes 5 days. What happens if the symptoms return at any point in that time

Player MUST STOP and rest until they are asymptomatic for 24hrs then they return to the level that they were at before

91

What is a basal skull fx

Fx at the base of the skull; accounts for % of Fx

92

What are the most prevalent SxS

Hemotympanum
Battles sign = mastoid process ecchymosis
Raccon eyes = periorbital ecchymosis
CSF leakage from nose/ears

93

Bleeding between the dura mater and arachnoid layer is called...

Subdural hematoma

94

Subdural hematoma is caused by...

Tearing of the "bridging veins" during a shearing injury (acceleration-deceleration injury)

95

What are major RFs for subdural hematoma

Age (elderly) and anticoagulation are major

96

SxS of subdural hematoma are...

Confusion
Slurred speech
HA
Lethargy
LOC
N/V
Weakness

97

What is the main diagnostic test? What is its classic result

CT scan
Crescent shape with midline shift of ventricle

98

What is the Tx of subdural hematoma

Small one = burr holes
Larger one = craniotomy to evacuate clots

99

Bleeding between the dura mater and skull is called

Epidural hematoma

100

Epidural hematoma is due to...

Trauma/skull fx

101

Epidural hematoma is caused by...

Tearing of the middle meningeal artery

102

What is the classic presentation of epidural hematoma

Initial LOC followed by lucid state
"Talk and die"

103

What is the diagnostic test of choice? What is the finding/result

CT
Shows biconcave lens (looks like lens with part outside and part inside skull)

104

What is the Tx for epidural hematoma

Surgical evacuation & ligation of bleeding vessels

105

Bleeding into the subarachnoid space is...

Subarachnoid hemorrhage

106

Subarachnoid hemorrhage is usually due to...

Rupture of a cerebral aneurysm (but can also be due to trauma)

107

What is the classic presentation of subarachnoid hemorrhage

Thunderclap HA or HA of a lifetime

108

What are other SxS of subarachnoid hemorrhage

HA
N/V
Stiff neck
Confusion
Seizure
May report popping/snapping prior to HA

109

What is the diagnostic of choice for subarachnoid hemorrhage?

CT without contrast (best within 12hrs then sensitivity decreases)

110

What is the diagnostic test to do if CT is inconclusive for suspected subarachnoid hemorrhage

Lumbar puncture (LP); presence of blood is positive result

111

What is the Tx of subarachnoid hemorrhage

Depends on size, location, etc.
Tx includes clipping or coiling procedures

112

Which type of stroke is more common; hemorrhagic or ischemic?

Ischemic (87% of all strokes)

113

Which causes more hemorrhagic strokes...intracerebral hematoma (ICH) or subarachnoid hematoma (SAH)

Intracerebral hematoma

114

What is the main cause for hemorrhagic stroke

Ruptured berry aneurysm (80%)

115

AV malformations also cause hemorrhagic stroke; what are the SxS of this

Pulsatile tinnitus, HA, & seizures

116

Where do most aneursyms occur/develop

Develop at the branching points of arteries

117

Where is the most common location for an aneurysm to occur

Anterior communicating artery

118

Why is hemorrhagic stroke so important (think prognosis)

B/c 10-15% die before reaching the hospital and 25% within the 1st 24hrs
1/3 of survivors will have neuro deficits

119

What are the management goals for hemorrhagic stroke

SBP < 140-160 w/o fluctuations
Monitor cardiac dysrythmias
ICP monitoring (< 20mmHg)
Normothermia

120

What is a sentinel bleed

A small bleed or warning leak at the site several days before the larger event; accompanied by milder HA, neck stiffness, and nausea

121

What are complications of hemorrhagic stroke

Rebleeding
Hydrocephalus
Cerebral ischemia (d/t vasospasm)

122

What are the two causes/types of ischemic stroke

Thrombotic or embolic

123

Which is more common...thrombotic or embolic ischemic stroke

Thrombotic

124

What causes thrombotic ischemic stroke

Atherosclerosis (injured endothelial lining allows platelets to adhere -> plaque formation)

125

What is the origin of most embolic ischemic strokes

Carotid arteries & heart (a-fib vegetation)

126

What is the least common cause of ischemic stroke

Lucunar infarcts

127

What is a TIA

Transient ischemic attack; sudden onset of neurological deficit including speech, hemiparesis, and monocular blindness

128

What is amaurosis fugax

Sudden, monocular blindness described as a shade/curtain being pulled over the affected eye

129

What diagnostic test do you do for ischemic stroke

Head CT (or MRI)
TEE for uspected cardiac source
Carotid US for carotid artery stenosis

130

What is the main way to differentiate TIA vs CVA

TIA = symptoms resolve within 24hrs (most within 10 minutes)

131

Why is TIA cause for concern

Stroke follows TIA within 90 days in 20-25% of cases

132

If ischemia occurs at the anterior circulation what artery is commonly invovled

Anterior cerebral artery

133

What are the SxS of anterior circulation ischemia

Confusion, amnesia, personality change, cognitive change, contralateral hemiparesis & sensory impairment, if left there is expressive aphasia, & eyes deviate TOWARD affected side

134

If ischemia occurs at the anterior circulation what artery is MOST commonly invovled

Middle cerebral artery

135

What is a common SxS of middle cerebral artery infarct

Neglect of the affected side

136

If ischemia occurs in the posterior circulation what arteries are commonly affected

Posterior inferior cerebellar artery
Vertebrobasilar artery
Posterior cerebral artery

137

What are SxS of posterior ischemic stroke

Nystagmus, ataxia, vertigo, dysphagia, dysarthria

138

What is TPA

Tissue plasminogen activator = clot buster

139

What are the indications for TPA

Age > 18
NIH stroke scale of 5+
< 3hrs since onset of SxS

140

How quickly should TPA Alteplase be given

10% of dose as immediate bolus and remainder given within 60min

141

Are there risks with TPA? If so why use it?

Yes there are risk; increases risk for ICH but we still use it since it prevents 11-13 deaths and disability for every 100 pts (benefit > risk)

142

What is the most common complication in stroke pts

Depression (30%)

143

What are the scores for the NIH stroke scale

0 = no stroke
1-4 = minor stroke
5-15 = moderate stroke
16-20 = moderate-severe stroke
21-42 = severe stroke

144

Major TPA contraindications include

Score < 5 on scale, seizure, glucose abnormalities, previous head injury/CVA (90 days), Hx of ICH, recent major trauma/Sx, GI or GU hemorrhage, bleeding condition

145

What causes carotid artery stenosis

Plaque formation/build up in the carotids

146

Where does carotid artery stenosis typically occur

The bifurcation and flow into the internal carotids

147

What diagnostic tests are used to determine carotid artery stenosis

Can use carotid US or MRA ($$$) however; current GOLD STANDARD = angiography (invasive)

148

When does carotid artery stenosis Tx require Sx

Asymptomatic pt with > 80% stenosis
Symptomatic pt with > 50% stenosis

149

When does carotid artery stenosis Tx require medical management

Asymptomatic pts with > 60% stenosis
Symptomatic pts with < 80% stenosis

150

What drugs are used in carotid artery stenosis Tx

Plavix or Dipyridamole + ASA = 37% RR reduction which is the best

151

Occlusion of a single deep penetrating artery is...

Lacunar infarct

152

Lacunar infarcts typically affect...

Deep nuclei (caudate, thalamus, putamen)

153

What is the most commonly affected area for bacterial meningitis

Subarachnoid space

154

What is the typical cause of bacterial meningitis

Hematogenous spread from OM, sinusitis, PNA, or immmunocompromised

155

What are the causative organisms of bacterial meningitis in neonates

Group B beta hemolytic strep and enteric gram neg bacilli

156

What are the causative organisms of bacterial meningitis in children

MC = H influenzae
Others = Neisseria meningitidis & S pneumoniae

157

What are the causative organisms of bacterial meningitis in adults

MC = S pneumoniae & N meningitidis
Others = Staph, H influenzae, Gram neg bacilli, Listeria

158

What are the causative organisms of bacterial meningitis in elderly

S pneumoniae, E coli, Klebsiella, Listeria

159

What are the classic SxS of bacterial meningitis

HA
Stiff neck
Fever
Photophobia

160

What are other SxS of bacterial meningitis

Mental status change, n/v, seizures, lethargy, and confusion
Infants = high pitched crying, refusal to eat, bulging fontanelles

161

What are the classic PE findings for bacterial meningitis

Nucchal rigidity, kerning's sign, brudzinski's sign, and maybe skin rash (65%)

162

What is the diagnostic choice for bacterial meningitis

LP
Cloudy is poor result

163

What is the 1st line Tx of bacterial meningitis

Pt under 50 y/o = vancomycin + ceftriaxone
Over 50 y/o = add ampicillin

164

What are some preventions of bacterial meningitis

Vaccines (pneumococcal & meningococcal)

165

When is bacterial meningitis contagious

7 days before illness and 24 hrs after Abx started

166

Which is more common...viral or bacterial meningitis

Viral

167

What are common causitive agents for viral meningitis

Enterovirus, HSV

168

Pt with viral meningitis may present with...

Flu like symptoms, HA, fever, malaise, photophobia, & meningeal irritation

169

How do you differentiate viral and bacterial meningitis

Impossible to determine from H&P so treat as bacterial until proven otherwise

170

Inflammation of the brain =

Encephalitis

171

What is the most common type of encephalitis

Herpes simplex encephalitis

172

Common SxS of encephalitis are

HA
Fever
Mental status change

173

What is the MC causative agent of herpes simplex encephalitis and where is it found

HSV1; primarily in trigeminal ganglion

174

Presence of the HSV1 causes severe...

Inflammation, edema, necrosis, and hemorrhage

175

What is the diagnostic of choice for herpes encephalitis? What other test is commonly done?

Gold standard = PCR PCE for HSV
Other test = LP to check CSF leukocytes, protein, and glucose

176

What is the imaging of choice for herpes encephalitis

MRI preferred over CT

177

What is the Tx of herpes encephalitis

Acyclovir +/- steroids

178

What is the leading cause of epidemic encephalitis

Arbovirus

179

West nile virus has an abrupt onset of SxS what are they

Fever, malaise, profound fatigue, weakness
+/- HA, eye pain, and n/v

180

What is the classic finding for west nile on PE

Occipital LAN
Other = conjunctivitis and flushing

181

What is the diagnostic of choice for west nile

IgM ELISA (positive 8-21 days post onset)

182

What type of encephalitis is common in HIV pts

CMV encephalitis

183

What commonly presents in conjuction with CMV encephalitis

Retinitis

184

What is the Tx of CMV encephalitis

Ganciclovir & foscarnet

185

What pathogen is in cat bite infections

Pasteurella multocida

186

What are the stages of syphilis

Primary = chancre, 21-90 days
Secondary = macular rash, 2-8 weeks
Latent = 1-20 years
Tertiary = 1-20 years

187

A common neuro complication of syphilis is tabes dorsalis...what is it and what are its SxS

It is peripheral neuropathy, an inflammatory process involving the dorsal root ganglion
SxS = lightening pains (abs & legs), decreased proprioception, vibratory sense, & DTRs, Argyll-Robertson pupil, and syphilitic paresis (dementia paralytica)

188

How do you Dx neurosyphilis

LP for CSF with FTA-ABS test

189

How do you Tx neurosyphilis

PCN and monitor CSF

190

What is the MCC of cerebral mass lesions in HIV pts with CD4 < 100

Toxoplasmosis (parasitic infection)

191

What is the diagnosic of choice and result for toxoplasmosis

CT scan = ring enhancing lesions

192

What sex is more likely to develop brain CA? What is the peak age

Men > women
Peak age = 65-79 y/o

193

What is the only truly proven risk factor for brain CA

High dose ionizing radiation

194

What is the most common type of brain CA

Meningioma

195

Who is more likely to develop a meningioma

Women 3X more

196

Where do meningiomas arise from

The meninges in the subarachnoid space

197

What are the 2 locations for meningiomas? What are the associated SxS of each

Intraventricular: SxS = ICP
Posterior fossa: SxS = CN abnormalities

198

What are the distinct radiological characteristics of meningiomas

Dura tail & indentation of the brain

199

What are the grades of meningiomas

Grade 1 = meningioma; bening
Grade 2 = atypical meningioma; not benign or malignant
Grade 3 = anaplastic meningioma; malignant & invasive

200

What is the Tx for meningioma

Watchful waiting
Craniotomy
Radiation (sterotactic radiation/radiosurgery, gamma knife)

201

What is the familial link of pituitary adenoma

Multiple endocrine neoplasia 1 (MEN1)

202

What is the most common type of pituitary adenoma

Prolactinoma

203

What cells are involved in prolactinomas? What are the SxS

Cells = lactotrophs
SxS = gallactorrhea & gynecomastia

204

What is the size classification for pituitary adenomas

Macroadenoma: 10+ mm
Microadenoma: <10 mm

205

This type of brain CA is not common, occurs near the pituitary gland, and is classified as a pituitary tumor even though it differs from a pituitary adenoma. What is it?

Craniopharyngioma

206

Where do pituitary adenomas arise from?
Where do craniopharyngiomas arise from?

Adenoma = cells in anterior lobe
Craniopharyngioma = cells in Rathke's duct

207

What are the SxS of craniopharyngioma

May disrupt pituitary fxn, may result in optic nerve compression, may have increased ICP

208

Where are schwannomas (accoustic neuromas) found?

Tumor of CN8

209

What/where do schwannomas arise from

Schwann cells

210

What is a major complication of a schwannoma

Involvement/impingement of CN7 which runs along CN8

211

Are schwannomas usually uni or bilateral

Unilateral except with neurofibromatosis

212

What is the main SxS of schwannomas

Unilateral hearing loss

213

What will the results be of the Rhine and Weber test with schwannoma

Rinne: AC > BC
Weber: lateralize to the unaffected side

214

What is the imaging study of choice for schwannoma

MRI
Will see growth in internal acoustic canal

215

What is the Tx of schwannoma

Keyhole Sx or retromastoid/retrosigmoid craniotomy

216

Where do gliomas arise from

Glial cells

217

What is the most common type of malignancy (glioma)

Astrocytoma

218

What are the grades for astrocytomas

Grade 1 = pilocytic; benign
Grade 2 = low grade; benign
Grade 3 = anaplastic; malignant
Grade 4 = gliobalstoma multiforme; very malignant

219

Who are brainstem gliomas MC in

MC in children

220

What is the most devestating pediatric malignancy

Diffuse Intrinsic Pontine Glioma (DIPG)

221

What is the Tx of brainstem glioma

Sx if possible but often resort to XRT

222

Where do ependyomas arise from

Ependymal cells

223

What is the problem with ependyomas

They block the CSF flow and cause hydrocephalus

224

What are the common locations of ependyomas

4th ventricle for kids (more common)
Spine for adults

225

What is the diagnostic test of choice for ependyoma

MRI

226

What is the Tx for ependyoma

Sx if possible
May or may not use XRT or chemo

227

Where do oligodendrogliomas arise from

Oligodendrocytes

228

What is the key characteristic of oligodendrogliomas

They are slow growing

229

What is the Tx for oligodendrogliomas

Watchful waiting or Sx if possible
XRT
Chemo = temozolamide

230

What is often involved in optic nerve gliomas

Optic chiasm

231

What condition are optic nerve gliomas associated with

Neurofibromatosis

232

What are the SxS of optic nerve gliomas

Vision changes & maybe hormonal disturbances

233

What is the imaging of choice for optic nerve gliomas

MRI

234

What are the 2 grades of pineal tumors

Low grade = pineocytoma (benin)
High grade = peneoblastoma (malignant)

235

What is the MC pediatric tumor

Medulloblastoma

236

Where are medulloblastomas found

ALWAYS in cerebellum

237

What are characteristics of medulloblastomas

Fast growing, high grade tumors

238

What is the Tx of medulloblastomas

Sx, radiation, +/- chemo

239

What are the most common primary CAs to met to the brain

Lung and breast CA

240

What are the types of neurofibromatosis

Type 1 = von Recklinghausen disease; 1/3,000
Type 2 = 1/25,000; autosomal dominant

241

What are the main SxS of type 1 neurofibromatosis

All the skin manifestations (pretty obvious)
15% will develop malignant gliomas

242

What is the most common cause of dementia

Alzheimer's

243

What are the 3 types of dementia

Cortical (AD, metabolic)
Subcortical (vascular dementia)
Mixed (Parkinson's, lewy body)

244

What are the main findings with AD

Amyloid plaques
Neurofibrilliary tangles

245

Which neurotransmitter is the problem with AD

Decreased ACh due to death of cholinergic neurons

246

How do you Dx AD

Dx of exclusion

247

What is the Tx of AD

Cholinesterase inhibitors (Aricept, Exelon, Reminyl)
NMDA receptors (Namenda)

248

What are RFs for multi infarct dementia

DM, CAD, HTN, CVA, smoking, men

249

What is the Tx of multi-infarct dementia

Manage RFs

250

Who is affected more by dementia with lewey bodies

Men

251

What are lewy bodies

protein deposits in nerve cells that can develop into plaques & tangles

252

What is the most prevalent SxS of lewy body dementia

Visual hallucinations

253

What is the Tx of lewy body dementia

Same meds as AD, may use Parkinson's meds too
Poor prognosis (dead 5-7years)

254

Picks disease is also known as

Frontotemporal lobar degeneration (FTD)

255

Why is FTD called picks disease

B/c of the abnormal protein-filled structures found in the pathology

256

What is the classic triad for normal pressure hydrocephalus

Gait instability
Urinary incontinence
Dementia
"Wobbly, wet, wacky"

257

What is the diagnostic study of choice for normal pressure hydrocephalus? What is the result

MRI
Shows ventriculomegaly (enlargement of ventricles)

258

What is the Tx of normal pressure hydrocephalus

Shunting may be best if responsive to LP

259

_________ is lacking in EtOH dementia

Thiamine (B1)

260

What are the tell tale SxS of wernicke's encephalopathy

Opthalmoplegia and verticle & horizontal nystagmus

261

The key finding in progressive supranuclear palsy is...

Paralysis of verticle gaze

262

What is the diagnostic test of choice for evaluation of new onset seizures

MRI unless suspected bleed

263

When can a pt stop taking seizure meds

When they are seizure free for 2 years and have a normal EEG

264

What are the SxS of absence seizures

NO AURA
Vacant, dazed expression
Staring
Pallor
Timing (10 seconds max, many times during day)
Post-ictal (picking clothes, pursing lips)

265

What is Tx for absence seizures

Zarontin
Depakote
Tx for 2 years then if seizure free wean off

266

What is generalized tonic clonic called

Grand mal seizure

267

What often precedes a grand mal

Aura with irritability, apathy, HA, scintillating scotoma, nausea, choking sensation, paresthesias

268

What are the SxS of grand mal

Sudden LOC, tonic, clonic, incontinence, tongue biting

269

What is the 1st line Tx of grand mal

Valproic acid (depakote)

270

What is the 2nd line Tx of grand mal

Dilantin or Tegretol

271

What seizure is characterized by sudden single or multiple jerks AKA infantile spasms

Myoclonic seizures

272

What are the SxS of atonic seizures

LOC, head drop w/ loss of posture, "drop attack" & falls

273

Simple partial seizures have _______ areas but may spread

Focal

274

Sensory SxS of simple partial seizures

Visual, auditory, olfactory, gustatory

275

Autonomic SxS of simple partial seizures

GI SxS, flushing

276

Motor SxS of simple partial seizures

Jerking limbs & paresthesias

277

Other SxS of simple partial seizures

Hallucinations, deja vu, jamais vu

278

Are simple partial seizures unilateral or bilateral

Unilateral

279

What is the Tx of simple partial seizures

Dilantin, Tegretol, Depakote

280

What is the most common type of seizure

Complex partial

281

Where do complex partials start? Where might they travel

Start = temporal
Travel to frontal

282

What may complex partials progress to

Grand mal

283

What are the SxS of complex partial

LOC
Aura (GI symptoms, sense of fear)
Stare, automatisms, facial movements

284

How long do complex partial seizures last

Lasts 30 sec - 2 min

285

What is the Tx of complex partial seizures

Tegretol, Dilantin, temporal lobe resection if meds fail for 2 years

286

Who gets rolandic epilepsy

ONLY children

287

What are the SxS of rolandic epilepsy

Face/cheek twitch
Drooling
Difficulty speaking
Often only occur during sleep

288

What is the Tx of rolandic epilepsy

Tegretol, Trileptal, Neurontin

289

Gelastic seizure is characterized by

Laughing outburst

290

Dacrystic seizure is characterized by

Crying outburst

291

Postictal period typically lasts_______ and has what SxS

Last 5-30 minutes
SxS = HA, exhaustion, confusion, drowsiness

292

What are the RFs for status epilepticus

MEDICATION WITHDRAWL
Alcohol withdrawl
Drug overdose
Intracranial infections
Neoplasms

293

What are the SxS of status epilepticus

Seizure lasting > 30min and/or 2+ seizures w/o recovery period

294

What is the 1st line Tx of status epilepticus

Lorazepam or daizepam

295

What seizure drugs should NOT be used in pregnant pts

Depicote & tegretol

296

What are cateminal seizures

Seizure in women with epilepsy due to progesterone withdrawl or mid-cycle estrogen surge

297

What drug is polycystic ovary disease related to

Valproate (Depakote)

298

Psychogenic nonepileptic seizure is AKA

"pseudoseizures"

299

Causes of pseudoseizures are...

Anxiety attacks/PTSD
Conversion disorder

300

What is atypical seizure activity

Nonfocal (opposite arm/leg)
Pelvic thrusting
Head turning side to side
Eyes closed (tight)
Tongue biting limited to tip
Postictal crying
Memory of event
May be triggered by emotional/stressful situation

301

Who is more likely to get MS

White > black
Female > male
Age 15-60

302

MS is an __________ disease resulting in.....

Autosomal disease results in demyelination of white matter

303

What are the types of MS

Relapsing remitting
Secondary progressive (Most Common!)
Primary progressive
Progressive relapsing

304

What is the presentation of MS

Sensory loss
Optic neuritis
Weakness
Paresthesias

305

What are other SxS of MS

Ataxia
Diplopia
Lhermitte sign
Telegrapghic speech
Dementia
Facial palsies
Impotence

306

What is the diagnostic of choice for MS

MRI shows spotty irregular demyelination

307

What is the 2nd diagnostic test for MS. What does it show

LP shows oligoclonal bands (bands of Ig)

308

What is the Tx of MS acute exacerbation

Methylprednisone IV x3days then switch to oral prednisone

309

What is the 1st line management of MS

Betaseron
Avonex
Rebif
Glatiramer

310

What is 2nd line management of MS

Mitoxantrone (Novantrone)

311

What is 3rd line management of MS

Natalizumab

312

What other things need to be managed in MS

Spasticity (Baclofen)
Pain (Amitriptyline)
Urinary (Ditropan or Detrol)
Constipation
Fatigue (Provigil)
Depression (SSRI)

313

What is the benign course of MS

1-2 relapses then recovery

314

What is commonly lost in pts with MS

Independent walking

315

What condition is a common development/association of MS

Optic neuritis

316

Is optic neuritis usually uni or bilateral?
What visual acuity constitutes

Usually unilateral with acuity of 20/100

317

What is the onset of optic neuritis

Usually hours to days

318

What are the PE results for optic neuritis

Optic nerve pallor
NORMAL pupillary reflex

319

This is an idiopathic, inflammatory neuropathy that affects men more than women and usually follows infection

Gullain barre

320

What neurons are affected by guillain barre

Sensory and motor

321

Gullain barre is an example of....

Antigen mimicry

322

What is the typical presentation of Guillain barre

Proximal muscle weakness
Legs affected more than arms
Myalgias (shoulder, back, thighs)
Paresthesias
Decreased DTRs

323

What are the types of Gullain barre

Acute inflammatory demyelinating polyadiculoneuropathy (AIDP) = 90%
Acute motor axonal neuropathy (AMAN)

324

What are the Txs for Gullain barre

Supportive or IVIg or plasmapheresis
Vaccinations (H1N1, tetanus, hepatitis)

325

What are long term effects of Gullain barre

Long term foot drop and hand weakness

326

What is the chronic form of Gullain Barre

Chronic idiopathic demyelinating polyneuropathy (CIDP)

327

Neuromuscular autoimmune disease with antibody formation to nicotinic ACh receptors

Myasthenia gravis

328

Drug induced myasthenia gravis

Tetracycline, aminoglycosides, propranolol, lithium

329

What are the main SxS of myasthenia gravis

Asymmetric proximal limb weakness
CN weakness (lid lag, ptosis, diplopia, facial weakness, slurred speech, fatigability)

330

What is the Tx of myasthenia gravis

Anticholinesterase inhibitors (Mestinon)
Immunosuppression (prednisone)

331

Bad complication of myasthenia gravis

Paralysis of respiratory muscles

332

Disorder characterized as persistent pain in dermatomal distribution

Postherpetic neuralgia

333

Degeneration of dopaminergic neurons in substantia nigra

Parkinson's

334

What are the SxS of Parkinson's

Rest tremor
Bradykinesia
Rigidity

335

What are common aspects of Parkinson's tremor

Rest tremor & pill rolling

336

What are common features of Parkinson's rigidity

Cogwheeling & lead pipe resistance

337

What are common features of Parkinson's bradykinesia

Micrographia & slow, shuffling gait

338

What is the diagnostic test of choice for Parkinson's

Spect imaging to see dopaminergic pathways

339

What is the primary Tx of choice for Parkinson's

Levodopa
Levodopa/carbidopa (Sinemet)

340

What are side effects of levodopa

Dyskinesias/choreiform movements

341

What is important to remember regarding Parkinson's Tx

After 5-10 years effectiveness wears off, pt experiences "on-off" stages

342

How do you get benign essential tremor

Autosomal dominant inheritance

343

What are exacerbating factors of benign essential tremor

Stress, fatigue, stimulants

344

What are alleviating factors of benign essential tremor

Alcohol & rest

345

Is benign essential tremor a rest or action tremor

Action tremor

346

What areas are commonly affected in benign essential tremor

Hands and head

347

What is the Tx of benign essential tremor

Beta blockers (propranolol, metoprolol)
Anticonvulsants (Primidone)

348

Autosomal dominant disease with mid-life onset

Huntington's chorea

349

What are classic SxS of huntington's chorea

Choreiform movements, mental decline/dementia

350

Which type of diabetes is more likely to develop diabetic polyneuropathy

Type 2

351

What is diabetic polyneuropathy associated with

Elevated HgbA1c

352

PE results of diabetic polyneuropathy

Decreased monofilament sensation, sharp/dull sensation, vibratory & proprioception sense, DTRs

353

What is the Tx of diabetic polyneuropathy

Optimize glucose control
TCA
Anticonvulsants
SNRI
Opiods (last resort)

354

Inflammation at the geniculate ganglion facial nerve linked with OM & herpes zoster

Bell's palsy

355

Red flags of bell's

Gradual onset > 2wks, no forehead involvement, bilateral involvement

356

What are the PE results of Bell's

Loss of nasolabial fold
Corner of mouth droops
Inability to close eye
Decreased lacrimation
INTACT SENSATION

357

What is the Tx of Bell's

Steroids and antivirals within 72hrs (acyclovir)