NEURO Flashcards by Brooke Bekkedahl

A pt with a tremor that occurs when their hand is outstretched or they go to reach for something, but not at rest, is known as what?

Essential tremor

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What might a pt report with an essential tremor?

It is improved with alcohol

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How do you treat an essential tremor?

Propranolol

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What movement disorder is inherited, occurring at a younger age, with choeiform movements?

Huntington’s disease

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A decrease in dopamine is associated with what movement disorder?

Parkinson’s

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What are some of the sxs of Parkinson’s?

pill rolling (at rest or with intention), bradykinesia (slow movement), cogwheeling, masked facial expression, micrographia, stooped posture, shuffling gait

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How do we treat Parkinson’s?

Anticholinergics, amantadine for older adults

Levodopa for advanced patients

*Start treatments when function is impaired

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What is the most common form of dementia?

Alzheimer’s

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What form of dementia has a slow/gradual onset, over 8-10 years?

Alzheimer’s

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If a patient is having difficulties with memory, they can’t seem to learn new info but their motor and sensory function is spared – what disorder?

Alzheimer’s

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What form of dementia has gradual onset, but also involves hallucinations, visuospatial fluctuations along with Parkinsonism?

Lewy Body dementia

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Lewy body dementia is associated with what portion of the brain?

basal ganglia

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If a patient is having difficulties with language and executive functioning – what disorder?

Frontotemporal dementia

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If on MRI a pt has cortical & subcortical changes with sudden almost stepwise changes in function – what disorder?

Vascular dementia

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What should be done on PE in a pt with dementia?

neuro exam, mental status, functional status (SLUMS, mini-cog, MMSE)

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What’s the first question of a MMSE?

Orientation – what’s the year, season, month, date, day

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What occurs in a mini-cog exam?

Remember/repeat 3 words
 
Draw a clock with hands at a specific time
 
Recall the 3 words

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What type of labs should we order in a pt we suspect dementia?

CBC, Na, BUN/Cr, Fasting Glucose, RPR, TSH, B12

Possible UA, folic acid, and liver function

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In a pt we suspect dementia, when would we consider imaging?

onset <65; focal sxs; concern from hydrocephalus; recent fall or head trauma

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What are some non-pharm options for tx dementia?

cognitive rehab, therapy, physical & mental activity; attention to safety

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What is being broken down too quickly with dementia?

Acetylcholine

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What medications slow the breakdown of acetylcholine and are prescribed for dementia? Give some examples

Cholinesterase inhibitors

Ex: Donepezil or memantine

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What should you always keep on your DDx in a patient you’re concerned has dementia, and thus we may treat them for this as well?

Depression

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What disorder involves idiopathic demyelinating affecting the white matter of the CNS?

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Who is affected by MS, and how do we diagnose it?

Women and peaks in 20-30’s Diagnosed by 2 or more clinically distinct episodes of CNS dysfunction separated by space and time Motor dysfunction, diplopia, gait disturbance, bowel/bladder dysfunction, and sexual dysfunction (Lhermitte sign = electric shock that runs down the spine and limbs with neck flexion)

How do we confirm diagnosis of MS?

clinical + MRI with gad to show cerebral or spinal plaques | LP shows oligoclonal bands

How do we treat MS?

Glucocorticoids (acute) Interferon beta, glatiramer, natalizumab (chronic)

If there is a LOC with a seizure, what is it?

Generalized seizure (convulsive or not – absence)

If there is NO LOC with a seizure, what is it?

Simple partial seizure (jacksonian seizure) Complex partial seizure (auras)

If a child is staring off into space, with moments of blankness, constant blinking or lip smacking – dx?

Absence (petite-mal) seizure

What is the temporary paralysis after a seizure known as?

Todd’s paralysis

How do we work-up a seizure?

Labs (CBC, electrolytes, glucose, Ca, Mg, renal function, and tox) CT or MRI and EEG

How do we treat seizures? Who cannot take those medications?

carbamazeprine, phenytoin, and Valproate (valproic acid) *women who are preggo, and those of child bearing age need extra folic acid

At what point do we prescribe anticonvulsant medications?

DO NOT USE in the setting of a single unprovoked seizure in a pt with a normal neurologic exam

How do we treat an absence seizure?

Ethosuximide

If the CT or MRI after a seizure is negative and no provoking stimuli is found, what dx?

Epilepsy

For status epilepticus what is the Tx?

1. Lorazepam 2. Phenytoic (valproic acid) 3. Phenobarbital (propofol)

What are some of the risk factors to a stroke?

HTN!! (MOST POWERFUL RF) Smoking*; atherosclerosis elsewhere; DM*; AFib Other: male, ETOH, hyperlipidemia, AIDS, previous stroke

A lacunar infarct is occurring where? What type of sxs are associated with these?

SMALL VESSEL Disease May be without findings – incidental on CT

A cerebral emboli stroke is what?

Embolism from heart or artery breaks off and occludes a distant vessel  in the brain

What type of stroke is often associated with Afib and is the reason why it’s so important to anticoagulate pt’s with afib?

Cardioembolism

What artery is affected when a pt has contralateral hemiplegia (hemiparalysis) after a stroke?

Middle Cerebral Artery

What artery is most commonly occluded during a stroke?

Middle Cerebral Artery

If this artery is occluded during a stroke it can lead to loss of several reflexes (grasp, suck), paralysis of foot/leg, urinary incontinence, and behavioral changes.

Anterior Cerebral Artery

If an occlusion occurs in this area of the brain it will results in visual deficits and changes in pupils/sensations?

Posterior Circulation

If a pt has transient monocular blindness – what does that mean, what is it called?

Embolism of ophthalmic artery - Amaurosis Fugax

If it is an acute stroke, what imaging do you need? What are you ruling out?

CT scan | R/O Hemorrhage

After a CT scan what’s the next imaging needed? What’s technically the gold standard?

MRI Gold Standard = Arteriography

During an acute stroke what do we do if their BP is 180/90?

LEAVE IT – avoid rapid BP reduction

During an acute stroke what do we do if their BP is 203/100?

Okay now you need to lower it – SLOWLY!

So, how do we treat an acute stroke?

Once hemorrhage has been ruled out… <3 hours = TPA + full anticoagulation

What are contraindications to TPA?

``` Previous stroke or recent bleeding/major surgery BP >185/110 Neoplasm Glucose <50 & platelets <100,000 Heparin use within 48 hours ```

If the cause of a pts stroke is an embolus from the heart – how do we treat?

Full anticoag

What’s the difference between a stroke & TIA?

Stroke = sxs >24 hours, irreversible damage TIA = sxs <24 hours, reversible

What surgical treatment is available for a TIA?

carotid endarterectomy or carotid angioplasty/stenting

What pharm Tx is available for TIA? When do we initiate it?

ASA If Pt is a poor operative candidate, <70% stenosis

If a pt presents with fever, AMS, a stiff neck, HA, and photophobia – what do you think? What do you do on PE?

Meningitis *Nuchal rigidity – KERNIG (supine, flex the knee, resistance to extend the knee) BRUDZINSKI (supine, lifting the head causes the hip to flex)

In a pt you are concerned has meningitis also has petechial rash what do you think is the cause?

N. meningitis

How do you work up a pt you are concerned about meningitis?

CT LP

If a LP shows WBC over 1,000, increased proteins, and decreased glucose – what do you think?

Meningitis

What is the MC cause of meningitis

Strep pneumo; Neisseria meningitides; HIB; Listeria

What type of bacteria would we see in a 50 y/o male with meningitis?

Listeria

What is the MC cause of meningitis in an infant?

Group B strep

How do we treat meningitis?

Emperically with dexamethasone, ceftriaxone, and vanco

What would you give a 50 y/o with meningitis?

Ampicillin

What can you not use in a child in the first month of life to treat meningitis?

Ceftriaxone GIVE = ampicillin, cefotaxime, +/- genatmycin

How do we confirm cure of meningitis?

CSF re-test in 24 hours, should be clear

What would the CSF look like in viral meningitis?

``` More lymphs WBC less than 1,000 Protein and glucose are normal ```

How do we treat viral meningitis?

Supportive (cause is HSV)

What disorder causes unilateral facial paralysis where a pt cannot raise the eyebrow? Cause? Tx?

``` Bell’s Palsy Cause = herpes simplex virus Tx = course of oral prednisone to help with full recoverys, usually self-limiting ```

A pt presents with bilateral distal extremity weakness that ascends up the legs. It is somewhat painful and DTR’s a decreased. – Dx? Cause? Workup?

``` Guillian- Barre Campylobacter jejuni EMG and CSF (may see elevated proteins) ```

How do we treat guillian-barre?

``` Hospitalize pts to watch respiratory status Plasmapheresis ASAP or IVIG Rehab ```