Neurology Flashcards
1
Q
3 broad pathological causes of AMS
A
systemic infxn
metabolic dysfxn
vascular events
2
Q
what tx can be diagnostic and therapeutic for a common drug related cause of AMS
A
naloxone
3
Q
general tx for AMS
A
- ABCs
- BG
- thiamine plus dextrose
- +/- naloxone
4
Q
abrupt and transient LOC caused by cerebral hypoperfusion
A
syncope
5
Q
t/f: all syncope needs full work up
A
t!
6
Q
5 causes of syncope
A
CVD/structural heart dz
arrhythmia
hypovolemia
orthostatic hypotn
sz
7
Q
general management of syncope
A
cardiac monitoring
CT
obs
8
Q
glasgow coma scale
A
9
Q
3 causes of numbness/paresthesia
A
DM
nerve root pathology
CNS pathology
10
Q
abnormal dermal sensation due to compromised nerve fxn
A
paresthesia
11
Q
a pt may describe paresthesia as (5)
A
prickling
tingling
itching
burning
cold skin
12
Q
work up for paresthesia in the emergency setting must include
A
brain CT vs MRI
13
Q
sudden onset unilateral facial nerve paralysis w. no other focal neuro/systemic findings
A
bell’s palsy
14
Q
60% of bells palsy cases involve a _ prodrome,
and symptoms peak in _ hr
A
viral
48
15
Q
how do differentiate bells palsy vs CVA
A
bells palsy does not spare the forehead
if they can raise their eyebrows, so should you
16
Q
mc cause of bells palsy
A
HSV
17
Q
tx for bells palsy
A
prednisone
artificial tears
eye patch
18
Q
bilateral bells palsy makes you think of (2)
A
lyme dz
mono
19
Q
common presentations of encephalitis (4)
A
AMS
sz
personality changes
exanthema
20
Q
encephalitis is differentiated from meningitis by
A
altered brain functioning
21
Q
mc cause of encephalitis
A
HSV
immunocompromised: CMV
22
Q
rapidly progressive encephalopathy w. hepatic dysfxn that is usually post flu/URI
A
reye’s syndrome
23
Q
2 PE findings of reye’s syndrome
A
positive babinski
hyperreflexia
24
Q
2 pharm causes of reye’s syndrome
A
ASA
pepto
25
lab findings of reye's syndrome
elevated:
LFTs
PTT
NH3
hypoglycemia
metabolic acidosis
26
tx for reye's syndrome
supportive
IV acyclovir asap
+/- abx til meningitis is ruled out
27
sx of reye's syndrome
fever
HA
AMS
personality changes
sz
exanthema
28
what is exanthema
a skin rash accompanying a dz or fever
29
dx for reye's syndrome
LP
MRI
PCR
30
2 types of sz in ED setting
status epilepticus
focal sz
31
what is status epilepticus
sx >/= 5 min continuous
OR
more than one sz w.o recovery from postictal state
32
always check _ when pt presents w. sz
finger stick BG
33
tx if pt on TB meds presents w. sz
B6 for INH toxicity
34
mc cause of sz in emergency setting
change in meds of someone w. sz d.o
35
emergent management of sz
-place in lateral decubitus position
-IV benzos/phenytoin/phenobarbital/lacosamide
-correct acidosis
36
sz lasting > _ min may result in permanent brain damage
60
37
types of focal sz
-simple partial (retained awareness)
-complex partial (loss of awareness)
38
tx for focal sz
phenytoin
vs
carbamazepine
39
types of generalized sz (9)
absence (petit mal)
tonic-clonic (grand mal)
atonic
clonic
tonic
myoclonic
febrile
infantile spasm
psychogenic nonepileptic
40
-brief mental status change w.o motor activity
-no aura, post ictal state, or loss of postural tone
absence sz
41
absene sz is mc in what pt pop
5-10 yo
42
EEG findings of absence sz
brief 3 Hz spike and wave discharge
43
tx for absence sz
ethosuximide
44
-convulsive bilaterally symmetric sz w.o focal onset
-begins w. LOC
tonic-clonic sz
45
describe the phases of tonic clonic sz
tonic: stiff/rigid 10-60 sec
clonic: convulsions
post ictal: confused
46
drop attack (similar to syncope)
loss of muscle tone
atonic sz
47
-loss of control of bodily fxn - jerking
+/- LOC
clonic sz
48
extreme rigidity followed by LOC
tonic sz
49
muscle jerking, no tonic phase
occurs early in the AM
myoclonic sz
50
parameters for febrile sz (3)
temp > 38
> 6 mo, < 5 yo
absence of CNS infxn/inflammation
51
infantile spasm is a type of _ sz
epileptic
52
what sz is not due to epilepsy but presents similar to an epileptic sz
psychogenic non epileptic
53
work up for focal/generalized sz
check lytes/BG
pregnancy test
ECG/EEG
54
adults w. first seizure have bought themselves
CT/MRI
55
8 common causes of sz
lytes disturbance
infxn
toxic ingestion
trauma
azotemia
hypoxia
hypoglycemia
stroke/bleed
56
5 meds used for focal sz
phenytoin
phenobarb
valproate
lamotrigine
gabapentin
57
2 types of hematoma
epidural
subdural
58
27 yo, mountain bike vs tree, no helmet - admits to LOC but now feels fine - several hr later he decompensates quickly
epidural hematoma
59
progression of epidural hematoma
transient LOC -> lucid -> HA -> unilateral/contralateral weakness
60
cause of epidural hematoma
trauma to skull -> blood between dura and skull
61
artery mc involved w. epidural hematoma
middle meningeal
62
imaging for epidural hematoma and hallmark finding
-non contrast CT
-lenticular, unilateral convexity -> lens shape/lemon in temporal region
63
tx for epidural hematoma (4)
surgical craniotomy
mannitol, steroids
hyperventilate
ventricular shunt
64
73 yo M w. hx afib on warfarin - presents after fall w. syncope - quickly becomes unconscious
subdural hematoma
65
mc pt pop affected by subdural hematoma
**elderly** and **alcoholics**: fall -> tear bridging veins
66
classifications of subdural hematoma
acute: 48 hr
subacute: 3-14 days
chronic: > 2 weeks
67
w. subdural hematomas, blood collects between the _ and _
dura and arachnoid mater
68
dx for subdural hematoma and hallmark finding
non contrast CT
crescent shaped concave hyperdensity
69
tx for subdural hematoma, small vs severe
small: obs
severe: surgery -> burr hole vs trephination, craniotomy vs craniectomy
70
what is this showing
epidural hematoma
*epi = pie, lemon pie*
71
what is this showing
subdural hematoma
*sub = b = banana*
72
mc causes of spinal cord injury
trauma
disease
73
classifications of spinal cord injury (4)
anterior cord syndrome
central cord syndrome
complete cord transection
brown-sequard (hemisection)
74
-loss of pain/temp below the level of the lesion
-preserved position/vibration/touch
anterior cord syndrome
75
-loss of pain and temp sensation at the level of the lesion
central cord syndrome
76
-complete loss of movement and sensation below the level of injury
-urinary retention, distended bladder
complete cord transection
77
-loss of proprioception and vibration on teh same side as the lesion
-loss of pain/temp on the opposite side a few levels below the lesion
brown-sequard (hemisection)
78
-ascending paralysis beginning in distal limbs/leg weakness -> total paralysis of all 4 limbs, facial muscles, eyes, reflexes
guillain-barre
79
2 causes of guillain barre
-post immunization
-post infectious
80
infxn mc associated w. guillain barre
**campylobacter jejuni **
also CMV, EBV, HIV
81
dx and tx for guillain barre
dx: LP
tx: plasma excange PLUS IVIG
82
LP findings of guillain barre (2)
elevated protein
normal WBC
83
2 forms of status epilepticus
convulsive
nonconvulsive
84
sz characterized by regular pattern of contraction and extension of arms and legs
convulsive status epilepticus
85
2 types of nonconvulsive status epilepticus
complex partial
absence
86
tx for status epilepticus
1. benzos
2. phenytoin
87
transient, traumatic brain dysfxn
concussion
88
6 sx of concussion
confusion
memory loss
LOC
HA
dizzy
n/v
89
concussion and _ are synonymous
mild TBI/mTBI
90
mTBI definition
-GCS 13-15 30 min post injury
-consciousness loss < 30 min
-post-traumatic amnesia < 24 hr OR other transient neuro abnormality (sz, focal deficits)
91
t/f: all pediatrics with mTBI need brain imaging
f!
92
what tool is used to determine who needs CT in peds >/= 2 yo w. mTBI
pecarn
93
what peds >/= 2 yo w. mTBI probs don't need imaging
normal mental status
no LOC
no vomiting
non severe MOI
no skull fx
no HA
94
tx for mTBI
-2-3 days of brain rest followed by gradual reintroduction of activity that does not worsen sx
-monitor for sx
-APAP/ibuprofen
-limit caffeine
95
when can kiddos return to sport after mTBI
only when full recovery is evident
96
2 types of stroke
**ischemic - mc**
hemorrhagic
97
2 types of ischemic stroke
thrombotic
embolic
98
-clot develops in the blood vessels inside the brain
-usually preceded by TIA
thrombotic stroke
99
-clot develops somewhere outside the brain
-occurs abruptly/w.o warning
embolic stroke
100
2 mc locations for embolic stroke to develop
aortic arch
large cerebral arteries
101
hemorrhagic strokes are mc due to
HTN
102
sx of hemorrhagic stroke
hemiparesis
hemisensory deficit
**present on one side only**
**present on side of body opposite stroke**
103
types of hemorrhagic stroke (8)
anterior
posterior
carotid/ophthalmic
MCA
ACA
PCA
basilar
lacunar
104
what arteries are involved w. anterior stroke
anterior cerebral
middle cerebral
105
sx of anterior stroke
aphasia
apraxia
hemiparesis
hemisensory loss
visual field defect
106
what arteries are involved w. posterior stroke
posterior cerebral
vertebral
basilar
107
sx of posterior stroke
coma
drop attack
vertigo
n/v
ataxia
108
what is drop attack
sudden fall w.o warning
+/- LOC or neuro sx
109
amaurosis fugax is associated w. aneurysm of what arteries (2)
carotid
ophthalmic
110
aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia
MCA stroke
111
leg paresis, hemiplegia, urinary incontinence
ACA stroke
112
coma, cranial n palsy, apnea, drop attack, vertigo
basilar a stroke
113
silent stroke
pure memory OR sensory
lacunar stroke
114
dx for stroke
**noncontrast CT**
transcranial doppler
ecoh for ischemic
115
tPA must be administered w.in _ hr of stroke sx onset
3-4.5
116
management of pt on tPA
-neuro exam:
-q 15 min during infusion
-q 60 min for the next 6 hr
-q 24 hr after tx
-serial BP
117
tPA exclusion criteria
-SAH
-head trauma
-prior stroke w.in past 3 mo
-MI w.in past 3 mo
-GI ulcer w.in last 3 mo
-major surgery in last 2 weeks
-hx ICH
-SBP > 185, DBP > 110
-active bleeding
-INR > 1.7 w. anticoagulation
-BG < 50
-sz w. postictal state
-multilobar infarct on CT
118
BP management for stroke pt
-hold antihypertensives until SBP > 220 OR DBP > 120
-goal: lower BP 15% in first 24 hr
119
for tPA to be administered, BP has to be _
< 185/110
120
how is BP lowered for stroke pt prior to tPA
IV labetalol 10-20 mg over 1-2 min
121
3 types of HA
cluster
tension
migraine
122
-which type of HA is always unilateral but side can vary
-mc in men
cluster
123
describe the pain w. cluster HA
excruciating
unilateral
124
sx of cluster HA (besides HA)
autononic:
ptosis
miosis
lacrimation
conjunctival injxn
nasal congestion
125
tx for cluster HA
**100% O2**
sumatriptan
prophylaxis: CCB
126
mc type of HA
tension
127
describe tension HA pain
bilateral
non pulsating
bandlike - frontal/occipital
neck muscle tenderness
128
4 common triggers for tension HA
stress
fatigue
glare
noise
129
tx for tension HA
NSAIDs
smoking cessation
130
5 common triggers for migraines
menstruation
pregnancy
contraceptives
chocolate/cheese/nitrites
etoh
131
describe migraine pain
mc unilateral
gradual onset
throbbing/pulsating
132
2 types of migraine
w. aura
**w.o aura - mc**
133
sx of migraine w. vs w.o aura
w. aura: scotoma (blind spot), flashing lights, sound
w.o aura: n.v, photophobia, phonophobia
134
mc type of migraine aura
visual
135
migrained follows aura w.in _ min
30
136
abortive vs prophylactic tx for migraines
abortive: triptans, dihydroergotamines (DHE), antiemetics, NSAIDs
prophylaxis: bb, ccb, TCAs
137
2 types of brain hemorrhage
138
"worst HA of my life"
SAH
139
sx of SAH
sudden, severe HA
LOC - 50% of pt
elevated BP
+/- fever
140
less severe but atypical HA that precedes SAH in 40% of pt's
herald bleed
141
mc type of nontraumatic SAH aneurysm
berry (saccular)
142
4 rf for SAH
smoking
HTN
hypercholesterolemia
heavy etoh
143
dx for SAH
non contrast CT
LP
144
LP findings of SAH
elevated opening pressure/grossly bloody fluid in all 4 tubes
145
tx for SAH
surgical clipping/wrapping
anticonvulsants
146
-abrupt focal neuro deficit that worsens steadily over 30-90 min
-HA, LOC, stupor, coma, vomiting
intracerebral hemorrhage
147
mc cause of ICH
HTN -> sudden increase in BP -> ruptured parenchyma
148
saccular aneurysms are almost always due to
hereditary malformation/weakness in BV of COW
149
mc cause of syncope
insufficient cerebral blood flow:
decreased CO or venous return
150
2 mc cause of syncope
vasovagal
idiopathic
151
6 red flags w. syncope
during exertion
multiple recurrences in short time
heart murmur
old age
significant injury during event
fam hx sudden/unexpected death
152
3 causes of acute loss of coordination/ataxia
infarction
edema
hemorrhage
153
when you see loss of coordination/ataxia, think _ involvement
cerebellar
154
common cause of chronic/progressive loss of coordination/ataxia
parkinsons
155
imaging for ataxia
MRI/CT w. AND w.o contrast
156
causes of ataxia
drugs/toxins
tumor
CVA
genetics
eustachian tube dysfxn
MS
stroke
huntington
fibromyalgia
metabolic disorders
157
transient episode of neuro dysfxn due to focal brain, retinal, or spinal cord ischemia w.o acute infarction
TIA
158
TIA lasts _ on average
and must last < _ by definition
-average: 15-30 min
-must last < 60 min, with reversal of sx w.in 24 hr
159
10% of TIA pt's will have a stroke w.in _ days
90
160
imaging for TIA
**CT w.o contrast **
carotid doppler US: looks for stenosis
CTA/MRA
161
carotid endarterectomy is indicated if common carotid artery stenosis is _
> 70%
162
pharm for for TIA
ASA + dipyridamole
OR
clopidogrel
163
_ criteria predicts likelihood of stroke w.in 2 days
**ABCD2:**
164
when is risk for CVA greatest after a TIA
24 hr after initial event
165
3 causes of memory loss
dementia
delirium
amnesia
166
mc cause of dementia after age 65
alzheimers
167
sudden, reversible change in mental status
delirium
168
3 common causes of delirium
**medical conditions:**
withdrawal from etoh/drugs/medicines
infxn/sepsis
sunstroke
169
4 common causes of amnesia
head injury
CVA
substance use
emotional event
170
criteria for delirium
-disturbed level of consciousness (attention/awareness)
-cognitive change (memory, disorientation, language, hallucinations)
-rapid onset (days-hr)
**-evidence of a causal physical condition**
171
sx of alzheimer's
-progresive memory loss
-difficulty word finding
-concentration problems
-emotional lability
-personality changes
-social withdrawal
-difficulty w. ADLs
172
2 mc types of dementia
**alzheimer**
vascular
lewy body
frontotemporal
neurodgenerative conditions
173
dx tool for dementia
**folstein MMSE**
memory impairment screen
174
2 early signs of alzheimers
language deficits
visuospatial deficits
175
5 rf for vascular dementia
HTN
dyslipidemia
DM
smoking
old age
176
what dementia is characterized by cognitive fluctuations, visual hallucinations, and parkinsonism
lewy body
177
what dementia is characterized by personality/social behavior changes and non-fluent speech
frontotemporal dementia
178
what neurodegenerative condition can cause dementia
huntington
179
6 reversible causes of dementia
B12 deficiency
syphilis
hypothyroidism
NPH
drugs
intracranial mass
180
2 drugs that may slow the progression of dementia
donepezil - cholinesterase inhibitor
memantine - NMDA agonist
181
sensation of movement in the absence of movement
vertigo
182
2 types of vertigo
peripheral
central
183
peripheral vertigo is _ dysfxn
central vertigo is _ dysfxn
peripheral: inner ear
central: brainstem
184
5 causes of peripheral vertigo
labyrinthitis
BPPV
meniere
vestibular neuritis
head injury
185
peripheral vertigo is characterized by (5)
sudden onset
n/v
tinnitus
hearing loss
**horizontal nystagmus**
186
5 causes of central vertigo
brainstem vascular dz
AVM
tumor
MS
vertebrobasilar migraine
187
central vertigo is characterized by (3)
gradual onset
**vertical nystagmus**
no auditory sx
188
vertigo + syncope =
vertebrobasilar insufficiency
189
positional vertigo w. no hearing loss, tinnitus, or ataxia
BPPV
190
dx and tx for BPPV
dx: dix hallpike
tx: epley, meclizine
191
non positional vertigo w.o hearing loss/tinnitus
vestibular neuritis
192
tx for vestibular neuritis
meclizine
193
acute, self resolving vertigo w. hearing loss
labyrinthitis
194
tx for labyrinthitis
meclizine
+
steroids
195
chronic, progressive, relapsing vertigo w. hearing loss/tinnitus
meniere's dz
196
tx for meniere's
diuretics
salt restriction
severe: CN VIII ablation
197
vertigo from trauma
perilymph fistula
198
tx for perilymph fistula
surgery
199
vertigo w. ataxia, hearing loss, tinnitus
neurofibromatosis type II
acoustic neuroma
200
meningitis triad
fever > 38
nuchal rigidity
HA
201
how is meningitis differentiated from encephalopathy
no AMS w. meningitis
202
kernig:
brudzinski:
kernig: neck pain w. knee extension
brudzinski: leg raise to compensate for pain w. neck bending
203
2 types of meningitis
aseptic: mc viral
bacterial
204
mc cause of bacterial meningitis
strep pneumo
*gram positive cocci*
205
meningitis w. a rash should make you think
n. meningitidis
*gram negative diplococci*
206
2 pathogens associated w. meningitis in neonates
e.coli
s.agalactiae
207
2 pathogens associated w. meningitis in pt's >50-60 yo
listeria
cryptococcus neoformans
208
pathogen associated w. HAP meningitis
staph
209
dx for meningitis
1. check for ICP/papilledema (CT if unsure)
2. LP
210
LP findings of bacterial vs aseptic meningitis
aseptic: normal pressure, lymphocytosis
bacterial: increased opening pressure and protein, decreased glucose
*think bacteria like to eat glucose*
211
tx for meningitis: aseptic vs bacterial vs household contacts
**aseptic:** symptomatic vs IV acyclovir if HSV
**bacterial:** dexamethasone, empiric IV abx
**household contacts:** rifampin, cipro, levaquin, azithromycin, ceftriaxone
212
abx for step pneumo meningitis
ceftriaxone
cefotaxime
vanco
pen g
213
