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Neurological Disorders Flashcards

1
Q

Example of 5HT-1 agonist

A

Sumatriptan (Imitrex)

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2
Q

Sumatriptan is contraindicated with

A

History of CVD

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3
Q

Sumatriptan can interact with

A
  • SSRI/SNRI –> risk of serotonin syndrome

- ergots

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4
Q

Side effects of Sumatriptan

A
  • flushing
  • tingling
  • chest/neck/sinus/jaw discomfort
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5
Q

Ergotamine/caffeine

A
  • Cafergot
  • potent vasoconstrictor
  • do not use with other vasoconstrictors
  • s/e: nausea
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6
Q

Antiemetics for abortive therapy

A
  • Trimethobenzamide (Tigan)

- Metoclopramide (Reglan)

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7
Q

Contraindications to vasoconstricting drugs

A
  • known or suspected CVD
  • Known or suspected CVA and/or TIA
  • HLD
  • males >40
  • menopausal females
  • uncontrolled HTN
  • Complex migraine
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8
Q

New onset headache in a middle/older adult is usually ___

A

secondary

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9
Q

Most common cause of stroke

A

Hemorrhagic

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10
Q

Risk factors for stroke

A
  • HTN
  • afib
  • stimulants (cocaine)
  • aneurysms
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11
Q

TIA resolves within

A

24 hours

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12
Q

Treatment for TIA

A
  • 911

- oxygen asap

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13
Q

long-term treatment for embolic stroke

A
  • anticoagulation with warfarin

- keep INR between 2-3

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14
Q

Long term teatment for hemorrhagic stroke

A

-avoid heparin, coumadin, aspirin

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15
Q

Cluster headache acute treatment

A
  • 100% oxygen at 12 L/minute

- intranasal 4% Lidocaine or intranasal sumatriptan

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16
Q

Cluster headache concerns

A

-may become suicidal

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17
Q

Cluster headache symptoms

A
  • severe “ice-pick”
  • behind one eye and temple
  • tearing, rhinorrhea, ptosis, miosis (Horner’s syndrome)
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18
Q

Horner’s syndrome

A
  • ptosis
  • miosis
  • facial anhidrosis
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19
Q

Gold standard diagnosis for GCA

A

-temporal biopsy

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20
Q

Plan for GCA

A

-STAT referral to optho or ED

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21
Q

First line treatment for GCA

A
  • High dose steroids

- Prednisone 40-60 mg PO daily

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22
Q

Persons with ___ are at high risk for GCA

A

polymylagia rheumatica

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23
Q

Patients with polymyalgia rheumatica present with

A
  • bilateral morning stiffness and aching
  • lasts 30 minutes or longer
  • usually a recent onset
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24
Q

Tension headache presentation

A
  • bandlike bilateral headache
  • dull and constant
  • tensing of neck muscles
  • reports increased life stressors
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25
Tension headache treatment
- NSAIDs, - analgesics - Combination OTC of analgesics,asa, caffeine - stress reduction and relaxation
26
Rebound headache
- daily headaches - irritability, depression, insomnia may be present - caused by overuse of abortive medications - discontinue or slowly taper
27
Bacterial meningitis presentation
- acute onset high fever - severe headeache - stiff neck - meningisimus - purple-colored petechial rash - N/V - photophobia
28
Is bacterial meningitis a reportable disease
yes
29
Romberg test; what system
cerebellar system
30
Romberg test procedure
stand with arms/hands straight on each side with feet together -positive: excessive swaying, falls down, keeps feet apart to keep balance
31
Tandem gait procedure
walk in straight line with heel to toe | -positive: unable to perform tandem walking
32
Coordination cerebellar tests
- Rapid alternative movements | - heel-to-shin testing
33
Sensory system cerebellar tests
- vibration sense - sharp-dull touch - temperature
34
Stereogenesis
ability to recognize familiar objects through sense of touch only
35
what system does stereogenesis test
cerebellar
36
Graphesthesia
ability to identify figures "written" on skin
37
Motor exam components
- Gait - pronator drift - gross leg and fine motor movements of hands
38
Normal reflex
+2
39
Sustained clonus reflex grade
+4
40
No reflex grade
0
41
Positive Babinski reflex
toes spread like a fan
42
Kernig's sign
flex patient's hips one at a time, then attempt to straighten the leg while keeping hip flexed at 90 -Positive: resistance to straightening because of painful hamstring and/or complains of back pain
43
Brudzinski's sign
- passively flex/bend the neck toward's chest | - Positive: patient reflexively flexes hips and knee to relieve pressure and pain
44
Nuchal rigidity
- tell patient to touch chest with chin | - positive: unable to touch chest secondary to pain
45
Offending bacteria for bacterial meningitis
- Streptococcus pneumoniae - Neisseria meningitidies - Haemophlius influenzae
46
Labs for bacterial meningitis
- Lumbar puncture: CSF with large WBCs - elevated opening pressure - CT or MRI - gram stain and C&S of CSF before antibiotics
47
Bacterial meningitis infants medications
-ampicillin or 3rd generation ceph
48
Bacterial meningitis adults medications
-3rd generation ceph plus chloramphenicol
49
Bacterial meningitis >50 medications
-amoxicllin plus 3rd gen ceph
50
Prophylaxis coverage for bacterial meningitis close contacts
rifampin | ceftriaxone
51
Complications of bacterial meningitis
-patients who recover usually have permanent neurologic sequelae
52
Trigeminal neuralgia aka
Tic Douloureux
53
Most common cause of carpal tunnel
-repetitive wrist/hand motion
54
Which nerve is compressed in CTS
median
55
Risks for CTS
- hypothyroidism - pregnancy - obesity
56
CTS presentation
- numbness/tingling on thumb, index finger, middle finger areas - hand grip weakened
57
Tinel's sign
- tap anterior wrist briskly | - positive: pins and needles sensation
58
Phalen's sign
- full flexion of wrist for 60 seconds | - positive: tingling sensation of median nerve
59
Which headache is treated with high-dose anticonvulsants
trigeminal neuralgia
60
Only bilateral headache
tension
61
Which headache is seen more in middle-aged males
cluster
62
Peripheral vertigo
involves vestibular system
63
central vertigo
involves brainstem or cerebellum
64
Benign paroxysmal vertigo is reproduced by which maneuver
Dix-Hallpike
65
Meniere disease characteristics
- recurrent - minutes to hours - acute onset - unilateral decrease/loss inhearing
66
Antihistamin medications for vertigo
Meclizine (antivert) Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl)
67
When to refer vertigo
most cases except BPV
68
Patients on ___ are at risk for B12 deficiency
- metformin | - increased after 4 years
69
Rest tremors
-occurs when tremulous body part is supported by gravity and not engaged in activity
70
Action tremor
occurs when body part is being used
71
Most common rest tremor
Parkinson's disease
72
Cardinal features of Parkinson's
- rest tremor - Bradykinesia - rigidity
73
PD treatment
MAOI Doapmine agonists anticholingergic medications doapmine replacement
74
MAOI
Rasagiline (Azilect) | Selegiline
75
Dopamine agonist
Pramipexole (Mirapex)
76
Anticholinergic medications for PD
Benztropine mesylate (Cogentin)
77
Dopamine replacement
-Carbidopa/levodopa (Sinemet)
78
How is PD diagnosis made
assessing response to dopaminergic therapy
79
Most common action tremor
essential tremor
80
When is essential tremor more common
older age
81
Where does essential tremor occur
bilateral action tremor of hands, forearms, head, voice, chin, lip -leg tremor is unusual
82
Clinical features of essential tremor
- apparent when arms are outstretched - more apparent at end of goal-directed movements (glass closer to lips) - no other neuro deficits
83
Eessential tremor treatment
- Propanolol | - primidone
84
Dementia diagnostic criteria
- at least 1 cognitive decline in these domains - learning and memory - language, - executive function - complex attention - perceptual-motor - social cognition - cognitive deficits must be severe enough to interfere with daily function
85
Most common dementia
Alzheimer's
86
Cognitive testing for dementia
- MMSE | - Montreal Cognitive Assessment (MoCA)
87
Delirium
acute onset
88
AD treatment
- acetylcholinesterase inhibitors | - Memantine (Namenda)
89
Acetylcholinesterase inhibitor examples
- donepezil (Aricept) - rivastigmine (Exelon) - galantamine (Razadyne)
90
Multiple sclerosis patho
demyelinating and dysmelinating - cause unknown - inflammation of nerves
91
MS presentation
- relapse and remissions - 15-50 years - optic neuritis - fatigue - bowel and bladder dysfunction - cognitive impairment - depression - eye movement abnormalities
92
Imaging for multiple sclerosis
MRI
93
Acute attack of MS treatment
-IV methylprednisolone with short prednisone taper
94
CN 1
olfactory
95
CN 2
optic | -Snellen chart
96
CN 3
oculomotor - eye movements - pupillary constriction - accomodation
97
CN 4
trochlear | -movement of superior oblique muscle
98
CN 5
Trigeminal - sensation to face, nasal and buccal mucosa, and teeth - motor division for mastication
99
CN 6
Abducens | -movement of lateral rectus muscle
100
CN 7
Facial | -innervates facial muscles and supplies taste to anterior 2/3 of tongue
101
CN 8
Vestibulocochlear | -hearing, balance, position
102
CN 9
Glossopharyngeal | -sensation to pharynx, posterior 1/3 of tongue, TM
103
CN 10
Vagus | -gag reflex, rise of uvula at midline
104
CN 11
Spinal accessory | -motor nerve supplying sternocleidomastoid and trapezius muscles
105
CN 12
Hypoglossal - Motor fibers to muscles of tongue - tongue sticks out at midline
106
What test treats BPPV
Epley maneuver
107
Acetylcholinesterase inhibitor mechanism
-prevents breakdown of acetylcholinesterase
108
Acetylcholinesterase side effects
- nausea - vomiting - diarrhea - decreased appetite - weight loss - bradycardia - hypotension
109
Vertical diplopia cranial nerve
-CN 4
110
Horizontal diplopia cranial nerve
CN 6
111
Both vertical and horizontal diplopia
CN 3
112
older adult concerned about misplacing items, is it concerning?
No, patient is able to self-report memory loss and continue working
113
Best antieplipetic for generalized seizures
valproate
114
Valproate serum levels
50-100
115
Status epilepticus
- seizure more than 5 minutes | - transfer to ER
116
NMDA receptor antagonist for dementia
Memantine
117
Migraine prophylaxis for pregnancy
-Riboflavin (B vitamin)
118
Acute angle glaucoma presentation
- one eye with pain - blurred vision - N/V - cornea hazy - pupil dilated midway
119
Acute angle glaucoma treatment
ED
120
Chronic subdural hematoma
-gradual and symptoms may not show until a few weeks after injury
121
Subarachnoid hemorrhage
- severe sudden headache - photophobia - N/V - meningeal irritation (stiff neck, positive Brudzinski, Kernig) - sentinal headache: sudden severe ehadache that resolves before major hemorrhage happens
122
Patients who experience TIA are at higher risk for stroke
True | up to 20% will have stroke within 90 days
123
First line treatment for trigeminal neuralgia
carbamazepine

Review (24 decks)

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