Neurology Flashcards
(26 cards)
What is the most common precipitating factor for hepatic encephalopathy in patients with cirrhosis?
GI Bleeding
What is the hallmark finding on mental status exam in hepatic encephalopathy?
Asterixis (flapping tremor)
Which substance accumulates in the brain and is most associated with the pathogenesis of hepatic encephalopathy?
What is the first-line treatment?
Ammonia
Lactulose and rifaximin
What is the role of rifaximin in hepatic encephalopathy management?
It reduces ammonia-producing gut bacteria
Which laboratory finding is most suggestive of hepatic encephalopathy in a patient with cirrhosis?
Elevated serum ammonia levels
What imaging study is most commonly used to rule out other causes of altered mental status in hepatic encephalopathy?
Non-contrast head CT
What dietary modification is recommended for patients with hepatic encephalopathy?
Reduced dietary protein intake
Protein recommendation is 1-1.5 g/kg/day
A 62-year-old man with a history of alcohol-related cirrhosis presents with confusion and lethargy. His family reports that he has not been compliant with his lactulose therapy. Physical exam reveals jaundice, ascites, and a positive asterixis. Labs show elevated ammonia levels, a prolonged PT/INR, and mild hypokalemia. What is the most appropriate initial treatment?
A. Lactulose and rifaximin
B. Thiamine and IV fluids
C. IV antibiotics and blood transfusion
D. Low-dose corticosteroids
Lactulose and rifaximin
Lactulose is first-line therapy for hepatic encephalopathy to reduce ammonia absorption. Rifaximin is often added for further ammonia reduction by targeting gut bacteria.
What is the most common cause of ischemic stroke?
Thromboembolism secondary to atherosclerosis
What is the first imaging study obtained in a suspected stroke?
Non-contrast CT of the head
What is the time window for intravenous thrombolytic therapy (tPA) in ischemic stroke?
What is a contraindication for administering tPA in ischemic stroke?
Within 4.5 hours of symptom onset
Active internal bleeding or recent major surgery
What scoring system is commonly used to assess stroke severity?
NIH Stroke Scale (NIHSS)
What is the target blood pressure for a patient receiving tPA?
< 185/110 mmHg
Which artery’s infarction causes contralateral hemiparesis and sensory loss predominantly in the lower extremities?
Anterior cerebral artery (ACA)
What condition must be ruled out before initiating thrombolytic therapy in ischemic stroke?
Hemorrhagic stroke
A 68-year-old woman presents with sudden onset right-sided weakness and difficulty speaking. She arrived at the ED 2 hours after symptom onset. CT head is negative for hemorrhage. Her blood pressure is 190/105 mmHg. What is the next best step in management?
A. Administer aspirin immediately
B. Initiate IV thrombolytic therapy (tPA)
C. Lower blood pressure to <120/80 mmHg before treatment
D. Perform a lumbar puncture
Initiate IV thrombolytic therapy (tPA)
The patient is within the 4.5-hour window for tPA, and there is no evidence of contraindications. Blood pressure should be lowered to <185/110 mmHg, but not aggressively, before administering tPA
A 72-year-old man presents with sudden left-sided hemiparesis, facial droop, and loss of sensation in his left arm and face. He also has expressive aphasia. Which artery is most likely involved?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Middle cerebral artery
MCA stroke causes contralateral hemiparesis and sensory loss, predominantly in the face and upper extremity, as well as language deficits if the dominant hemisphere is involved.
A 55-year-old man presents with sudden onset dizziness, difficulty walking, nausea, and slurred speech. On exam, he has ataxia, dysmetria, and nystagmus. What is the most likely location of the stroke?
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior inferior cerebellar artery (PICA)
D. Lenticulostriate arteries
Posterior inferior cerebellar artery (PICA)
Symptoms of dizziness, ataxia, and nystagmus suggest a posterior circulation stroke involving the cerebellum or brainstem
What condition can present with headache, vision loss, jaw pain, and temporal tenderness?
Giant cell temporal arteritis
A 33-year-old woman with a history of peptic ulcer disease presents to the emergency department with a unilateral, pulsatile headache that is 8/10 in severity. She has had similar headaches previously. This time, she was unable to control her symptoms at home with acetaminophen. Her neurological exam is within normal limits. Which of the following is the best treatment for this patient’s headache?
A) Ibuprofen
B) Morphine
C) Oxygen
D) Sumatriptan
Sumatriptan
What is the typical presentation of Reye’s Syndrome and what is the treatment?
What will labs show?
Patient will be a child with a history of recent viral infection treated with aspirin. They may have encephalopathy, delirium, seizures, or vomiting.
Treatment for Reye’s Syndrome is supportive care.
Hypoglycemia, elevated LFTs, hyperammonemia, metabolic acidosis
What is the treatment for status epilepticus?
What is second line treatment?
IV Lorazepam
Phenytoin or fosphenytoin, valproic acid, or phenobarbitol
What is the best benzodiazepine for treatment of status epilepticus in a patient without intravenous access?
IM Midazolam
What is the clinical presentation of anterior cord syndrome?
What is the typical mechanism of injury?
Complete loss of motor, pain, and temperature below injury, but proprioception and vibratory sense is in tact
Flexion or vascular injury
